目的:探讨两种微创技术即内窥镜辅助下椎弓根螺钉内固定技术、经皮Sextant内固定术治疗胸腰椎骨折的临床效果.方法:自2004年6月至2010年4月,胸腰椎骨折患者76例,男45例,女31例；年龄21～58岁,平均为36.4岁；分别采用内窥镜辅助下椎弓根螺钉内固定(A组24例),Sextant系统经皮椎弓根螺钉内固定手术(B组20例),传统后路切开复位椎弓根螺钉内固定手术(C组32例)治疗,观察并比较3组的临床及影像学各项指标.结果:所有病例获得随访,平均随访时间1年.术后1年取内固定,均未发现椎弓根螺钉内固定松动断裂.A、B两组在手术切口长度、术中出血量、术后引流量、术后住院时间及术后伤口疼痛VAS评分方面均优于C组(P＜0.05),但手术时间3组差异无统计学意义.术后3组的后凸Cobb角、损伤椎体前缘高度均较术前改善(P＜0.05).结论:在严格掌握手术适应证的前提下,与传统的开放性手术相比,微创椎弓椎螺钉内固定术治疗胸腰椎骨折具有创伤小、出血少、恢复快等优点,能够达到复位、固定、早期功能锻炼的目的.%Objective: To investigate the surgical therapeutic result of thoracolumbar fracture treated by two minimally invasive surgery or by traditional open operation. Methods:From June 2004 to April 2010,76 patients (45 males and 31 females,with an average age of 36.4 years,ranging from 21 to 58 years) with thoracolumbar fracture were divided into three groups. In group A,24 patients were treated with minimally invasive internal fixation by endoscope. In group B,20 patients were treated by Sextant percutaneous pedicle screws fiaxation. In group C, 32 patients were performed with traditional open fixation surgery. The perioperative index and radiographic factor were compared among the three groups. Results:All patients were followed-up for 1 year in average. The internal fixation devices were taken out averaged 1 year after operation, there were no complications related to the internal fixaton systems. The perioperative index of groups A and B including the incision size, surgical blood loss,surgical draining loss,hospital stay time and post-operation VAS score were significant smaller than group C (P<0.05). The Cobb's angle,sagittal index,and anterior height of the fracture vertebral body were all significantly different between pre-operation and post-operation in each group (P<0.05). Conclusion: These two methods of minimally invasive surgical treatments are effective and safe for patients with thoracolumbar fracture,because of less damage to muscles,less blood loss and quicker recovery,compared to the traditional open operation.
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