微创经皮椎弓根钉联合同切口通道减压术治疗胸腰椎爆裂性骨折的疗效与安全性研究

Efficacy and safety of minimally invasive percutaneous pedicle screw combined with co-incision channel decompression in treatment of thoracolumbar burst fractures

摘要:

目的 分析微创经皮椎弓根钉联合同切口通道减压术治疗胸腰椎爆裂性骨折的临床疗效和安全性。方法 选取2019年9月—2021年10月巴彦淖尔市医院收治的98例胸腰椎爆裂性骨折患者，按照随机数字表法分为研究组和对照组，每组49例。研究组行经皮椎弓根钉联合同切口通道减压术；对照组行经皮椎弓根钉内固定并后路常规减压术。术后随访6个月，比较两组手术情况、JOA评分、ODI、腰椎解剖学参数、椎管侵占率及并发症发生率。结果 两组手术时间比较，差异无统计学意义（P >0.05），研究组术中出血量和术后引流量少于对照组（P <0.05），住院时间短于对照组（P <0.05）。两组术前、术后3 d、术后7 d、术后1个月的视觉模拟评分法（VAS）比较：①不同时间点VAS评分有差异（P <0.05），两组术后3 d、术后7 d、术后1个月的VAS评分均低于术前（P <0.05）；②两组VAS评分有差异（P <0.05），研究组术后7 d、术后1个月的VAS评分低于对照组（P <0.05）；③两组VAS评分变化趋势有差异（P <0.05）。两组术前、术后6个月的日本骨科协会（JOA）评分及Oswestry功能障碍指数（ODI）差值比较，差异无统计学意义（P >0.05）。两组术前、术后6个月的伤椎前后缘高度比、后凸Cobb角差值、外旋活动度差值比较，差异无统计学意义（P <0.05）。两组术前、术后1个月、术后6个月的椎管侵占率比较：①不同时间点间的椎管侵占率有差异（P <0.05），两组术后1个月、术后6个月的椎管侵占率低于术前（P <0.05）；②两组的椎管侵占率无差异（P >0.05）；③两组的椎管侵占率变化趋势无差异（P >0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。结论 微创经皮椎弓根钉联合同切口通道减压术治疗胸腰椎爆裂性骨折可获得满意临床效果，在减少手术创伤、缩短住院时间方面具有一定优势。

Abstract:

Objective To analyze the efficacy and safety of minimally invasive percutaneous pedicle screw combined with the same incision channel decompression in the treatment of thoracolumbar burst fractures.Methods Ninety eight patients with thoracolumbar burst fracture who were treated in our hospital from September 2019 to October 2021 were selected and divided into a study group and a control group by random number table method, with 49 cases in each. The study group underwent percutaneous pedicle screw decompression combined with the same incision channel, while the control group was received percutaneous pedicle screw internal fixation and conventional posterior decompression. Two groups were followed up for 6 months after operation. The operation conditions, pain and lumbar function were compared between the two groups. The changes of lumbar anatomical parameters and spinal canal invasion rate were compared between the two groups. The incidence of complications in the two groups was counted.Results There was no significant difference in operation time between the two groups (P > 0.05). The intraoperative blood loss, postoperative drainage and hospital stay in the study group were lower than those in the control group (P < 0.05). The visual analogue scale (VAS) of pain before operation, 3d after operation, 7d after operation, and 1 month after operation between the two groups was compared, and the VAS score at different time points was different (P < 0.05), VAS scores of the two groups at 3d, 7d, and 1 month after surgery were lower than before surgery (P < 0.05). VAS score of the last month was lower than that of the control group (P <0.05), and the change trend of the VAS score between the study group and the control group was different (P < 0.05). There was no significant difference in the differences of the Japanese Orthopaedic Association (JOA) score and Oswestry Disability Index (ODI) between the two groups before operation and 6 months after operation (P > 0.05). There was no significant difference in the ratio of the height of the anterior and posterior edges of the injured vertebrae, the difference in the Cobb angle of kyphosis, and the difference in the range of motion of external rotation between the two groups before operation and 6 months after operation (P > 0.05). There were differences in the spinal canal invasion rates between the two groups before surgery, 1 month after surgery, and 6 months after surgery (P < 0.05). The invasion rate of spinal canal at 1 month and 6 months after operation in both groups was lower than before operation (P < 0.05). There was no difference in the invasion rate of the spinal canal between the study group and control group (P > 0.05). There was no difference in the change trend of spinal canal invasion rate between the study group and the control group (P > 0.05). There was no significant difference in the incidence of total complications in two groups (P > 0.05).Conclusion Minimally invasive percutaneous pedicle screw combined with co-incision channel decompression in the treatment of thoracolumbar burst fractures can achieve satisfactory clinical results. It has certain advantages in reducing surgical trauma and hospitalization time.