全程可视化系统辅助与徒手椎弓根螺钉内固定治疗无神经症状型胸腰椎爆裂骨折的疗效比较  

Comparative efficacy of whole‑process visualization system‑assisted pedicle screw internal fixation and free‑hand pedicle screw internal fixation in the treatment of thoracolumbar burst fracture without neurologic symptoms

作　　者：姜文涛[1] 梅伟[1] 潘强强 邵哲 刘沛霖[1] 张振辉[1] 苏锴 康永生[1] 王庆德[1] Jiang Wentao;Mei Wei;Pan Qiangqiang;Shao Zhe;Liu Peilin;Zhang Zhenhui;Su Kai;Kang Yongsheng;Wang Qingde(First Department of Spinal Surgery,Zhengzhou Orthopedic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州市骨科医院脊柱骨科Ⅰ,郑州450052

出　　处：《中华创伤杂志》2025年第2期157-163,共7页Chinese Journal of Trauma

摘　　要：目的比较全程可视化系统辅助与徒手椎弓根螺钉内固定治疗无神经症状型胸腰椎爆裂骨折(TLBF)的疗效。方法采用回顾性队列研究分析2020年12月至2022年10月郑州市骨科医院治疗的64例无神经症状型TLBF患者的临床资料,其中男41例,女23例;年龄23~52岁[(42.1±6.6)岁]。损伤椎体:T1126例,T1217例,L112例,L29例。手术均经Wiltse入路,其中31例采用全程可视化系统辅助椎弓根螺钉内固定治疗(可视化置钉组),33例采用徒手椎弓根螺钉内固定治疗(徒手置钉组)。比较2组手术时长、单枚螺钉置入时长、术中总辐射量、术中出血量、住院总时长;椎弓根螺钉置钉准确率和椎弓根皮质骨穿透率;术前和术后1周、3个月及末次随访时伤椎后凸Cobb角和腰部视觉模拟评分(VAS);术后并发症发生率。结果患者均获随访10~33个月[(17.5±4.8)个月]。可视化置钉组手术时长为(106.9±11.8)min,短于传统组的(121.3±11.4)min(P<0.01);可视化置钉组单枚螺钉置入时长为(9.1±1.0)min,短于徒手置钉组的(11.7±1.5)min(P<0.01);可视化置钉组术中总辐射量为(10.4±2.4)mGy,低于徒手置钉组的(51.8±7.2)mGy(P<0.01);2组术中出血量及住院总时长差异均无统计学意义(P>0.05)。可视化置钉组椎弓根螺钉置钉准确率为96.6%(197/204),高于徒手置钉组的89.3%(191/214)(P<0.01)。术后1周、3个月及末次随访时,2组内Cobb角和VAS均较术前逐渐改善(P<0.05)。2组间各时间点Cobb角和VAS差异均无统计学意义(P>0.05)。可视化置钉组1例术后4 d切口感染,应用抗生素后痊愈;徒手置钉组1例术后2 d出现神经根刺激症状,进行翻修,术后7 d神经根刺激症状消失。术后2组并发症发生率差异无统计学意义(P>0.05)。随访期间,2组患者均未发生断钉、内固定松动、矫正丢失等情况。结论与徒手椎弓根螺钉内固定相比,全程可视化系统辅助椎弓根螺钉内固定治疗无神经症状型TLBF,能缩短手术时�Objective To compare the efficacy of whole⁃process visualization system⁃assisted pedicle screw internal fixation and free⁃hand pedicle screw internal fixation in the treatment of thoracolumbar burst fracture(TLBF)without neurologic symptoms.Methods A retrospective cohort study was conducted to analyze the clinical data of 64 patients with TLBF without neurologic symptoms admitted to Zhengzhou Orthopedic Hospital from December 2020 to October 2022,including 41 males and 23 females,aged 23⁃52 years[(42.1±6.6)years].The injured vertebrae involved T11 in 26 patients,T12 in 17,L1 in 12,and L2 in 9.The Wiltse approach was used in all the patients,31 of whom were treated with pedicle screw internal fixation assisted by the whole⁃process visualization system(visualization system-assisted screw placement group)and 33 of whom were treated with free⁃hand pedicle screw internal fixation(free⁃hand screw placement group).The two groups were compared in terms of operation time,single screw placement time,intraoperative blood loss,intraoperative total radiation dose and total length of hospital stay.The accuracy of pedicle screw placement and penetration rate of the pedicle cortex were evaluated in the two groups.The Cobb angle and lumbar visual analogue scale(VAS)before surgery,at 1 week,3 months after surgery and at the last follow⁃up were compared between the two groups.The incidence of postoperative complications was also investigated.Results All the patients were followed up for 10⁃33 months[(17.5±4.8)months].The operation time was(106.9±11.8)minutes in the visualization system-assisted screw placement group,shorter than(121.3±11.4)minutes in the free⁃hand screw placement group(P<0.01).The single screw placement time was(9.1±1.0)minutes in the visualization system-assisted screw placement group,shorter than(11.7±1.5)minutes in the free⁃hand screw placement group(P<0.01).The total radiation dose was(10.4±2.4)mGy in the visualization system-assisted screw placement group,lower than(51.8±7.2)mGy i

关 键 词：脊柱骨折 胸椎 腰椎 外科手术 计算机辅助 可视化 

分 类 号：R683.2[医药卫生—骨科学]