经皮微创与传统开放椎弓根螺钉内固定治疗胸腰椎单椎体无神经症状压缩性骨折的比较

摘要

Objective To compare the clinical curative effect of percutaneous minimally invasive pedicle and traditional open pedicle screw fixation for thoracolumbar single vertebral body compressi-bility fracture without neurologic symptoms.Methods From December 2011 to December 2013,61 ca-ses of thoracolumbar single vertebral body compressibility fracture without neurologic symptoms un-derwent minimally invasive percutaneous(group A,31 cases)and traditional open(group B,30 cases) pedicle screw fixation,and we made a postoperative follow-up.Results The incision length,operative time,intraoperative blood loss,postoperative indices and the lengh of hospital day in group A were lower than group B.There was significant differences(P<0.05).Visual analogue scale(VAS)in 1 year preoperative and postoperative in two groups showed no significant difference,and there was significant difference in 3 days and 3 monthes postoperative,3 days postoperative group A were higher than group B,3 monthes postoperative group B were higher than group A.The serum creatine kinase showed sig-nificant difference of the two groups in 1 ,3 and 7 days postoperative,group A were lower than group B,but the overall trend was decline in both groups,the serum creatine kinase showed no significant difference of the two groups in 10 days postoperative.The kyphotic angle of fracture vertebral body showed no significant difference in two groups preoperative,postoperative instantly and follow-up.Conclusion Percutaneous minimally invasive pedicle screw fixation is worth to be used widely,which is safe and minimally invasive method for the treatment of thoracolumbar single vertebral body com-pressibility fracture without neurologic symptoms.%①目的比较经皮微创与传统开放椎弓根螺钉内固定治疗胸腰椎单椎体无神经症状压缩性骨折的临床疗效。②方法2011年12月～2013年12月，采用经皮微创（A组，31例）与传统开放（B组，30例）椎弓根螺钉内固定治疗胸腰椎单椎体无神经症状压缩性骨折患者，对其进行术后随访18～29个月。③结果 A组患者手术切口长度、手术时间、术中出血量、术后引流量和住院时间均低于 B组，差异有统计学意义（P ＜0．05）。视觉模拟评分（visual analogue scale，VAS）术前、术后1年两组无明显差异性；术后3天与术后3个月存在显著差异（P ＜0．05）：术后3天A组高于B组，术后3个月B组高于A组。两组患者血清肌酸激酶水平术后第1、3、7天存在显著差异，A组低于B组，但两组总体呈下降趋势；术后第10天两组血清肌酸激酶无明显差异。两组患者术前、术后即刻、随访时骨折椎体后凸角无明显差异；两组术后即刻、随访时均较术前明显改善，术后即刻与随访时无明显差异。④结论经皮微创椎弓根螺钉内固定技术治疗胸腰椎无神经症状压缩性骨折是安全的。