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不同入路椎弓根螺钉内固定治疗脊柱骨折临床疗效对比
Comparison of the Clinical Efficacy of Pedicle Screw Fixation by Different Approaches in the Treatment of Spinal Fracture

刘俭,孙立军.不同入路椎弓根螺钉内固定治疗脊柱骨折临床疗效对比[J].中国烧伤创疡杂志,2023,(5):371~375.

DOI：

英文关键词:Pedicle screw fixation Spinal fracture Traumatic stress Pain Spinal function

基金项目:

作者	单位
刘俭	112000 辽宁铁岭，铁岭市中心医院骨二科
孙立军

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中文摘要:

【摘要】目的对比分析不同入路椎弓根螺钉内固定治疗脊柱骨折的临床疗效。方法选取2019年1月至2020年12月铁岭市中心医院收治的90例脊柱骨折患者作为研究对象,按照不同手术入路方式将其分为后路组(48例)和开放入路组(42例),后路组患者行后路经皮微创椎弓根螺钉内固定治疗,开放入路组患者行传统切开复位椎弓根螺钉内固定治疗,对比观察两组患者术中出血量、手术时间、住院时间、创伤应激指标水平、疼痛程度、脊柱功能以及并发症发生情况。结果后路组患者术中出血量明显少于开放入路组(t=22.793,P<0.001),手术时间、住院时间均明显短于开放入路组(t=2.472、13.288,P=0.015、P<0.001);术后第1天,后路组患者血清皮质醇(Cor)、C反应蛋白(CRP)水平及红细胞沉降率(ESR)均明显低于开放入路组(t=2.273、5.735、3.265,P=0.025、P<0.001、P=0.002);术后1周,后路组患者视觉模拟评分法(VAS)评分明显低于开放入路组(t=7.116,P<0.001);术后6个月,后路组患者Oswestry功能障碍指数(ODI)评分明显低于开放入路组(t=11.320,P<0.001);后路组患者术后并发症发生率为2.08%,明显低于开放入路组患者的术后并发症发生率21.43%(χ2=8.488,P=0.004)。结论与传统切开复位椎弓根螺钉内固定相比,后路经皮微创椎弓根螺钉内固定治疗脊柱骨折的术中出血量更少,手术时间和住院时间更短,术后机体应激反应及疼痛程度更轻,更有利于脊柱功能的恢复。

英文摘要:

【Abstract】 Objective To compare the clinical efficacy of pedicle screw fixation by different approaches in the treatment of spinal fracture. Methods 90 patients with spinal fracture admitted into Tieling Central Hospital between January 2019 and December 2020 were enrolled as research subjects, and divided into posterior approach group ( n = 48) and open approach group ( n = 42) based on different surgical approaches they received. Patients were treated with the posterior percutaneous minimally invasive pedicle screw fixation in the posterior approach group, while patients in the open approach group were treated with the conventional open pedicle screw fixation. The intraoperative blood loss, operation time, length of stay, levels of traumatic stress indexes, pain degree, spinal functions and occurrence of complications of patients were compared between the two groups. Results Compared with the open approach group, the intraoperative blood loss ofpatients was obviously less (t = 22.793, P < 0.001), and the operation time and length of stay were markedly shorter in the posterior approach group ( t = 2.472 and 13.288, P = 0.015, P < 0.001). On day 1 after surgery, the levels of serum cortisol (Cor) and C-reactive protein (CRP), and the erythrocyte sedimentation rate (ESR) of patients in the posterior approach group were all significantly lower than that in the open approach group (t = 2.273, 5.735 and 3.265, P = 0.025,P < 0.001, P = 0.002). One week after surgery, the visual analogue scale (VAS) score of patients was obviously lower in the posterior approach group compared with the open approach group (t = 7.116, P < 0.001). Six months after surgery, the score of Oswestry disability index ( ODI) of patients was also significantly lower in the posterior approach group ( t =11.320, P < 0.001). The incidence of postoperative complications was 2.08% in the posterior approach group, being obviously lower than the corresponding 21.43% in the open approach group (χ2= 8.488, P = 0.004). Conclusion Compared with the conventional open pedicle screw fixation, the posterior percutaneous minimally invasive pedicle screw fixation in the treatment of spinal fracture can realize better clinical efficacy, including less intraoperative blood loss, shorter operation time and length of stay, milder postoperative stress responses and pain, and is more favorable for the restoration of spinal functions.