开放性椎旁入路与经皮微创治疗无神经症状胸腰段爆裂性骨折疗效比较

摘要

Objective To compare the clinical efficacy of openning paravertebral approach and minimally invasive per-cutaneous for the treatment of thoracolumbar burst fracture without neurological symptoms. Methods 76 cases of thoracolum-bar burst fracture without neurological symptoms were randomly divided into open group (group O, n=38) and percutaneous minimally invasive group (group P, n=38). The Cobb angle and anterior vertebral height were used for image evaluation, as-sessed clinical function using visual analogue score (VAS) and Oswestry disability index (ODI) were used for clinical function assessment. Results There was no significant difference between the two groups in Cobb angle and anterior vertebral height (P>0.05), but there was significant improvement after surgery (P<0.01). On the first day after surgery, the VAS of group P was significantly improved compared with the group O (P<0.05). There was no statistical significance in VAS score preoperatively and 3, 6, 12 months after operation between the two groups (P>0.05). The rates of pain relief of group O was 57%, 65%, 77%, 80% preoperatively and first day, 3, 6, 12 months postoperatively. The rates of pain relief of group P was 68%, 75%, 74%, 80% preoperatively and first day, 3, 6, 12 months postoperatively. The ODI improvement rates of group O was 61%, 69% and 83% 3, 6, 12 months postoperatively, while the group P was 57%, 74% and 79%. Conclusion There are well clinical effect of percutaneous minimally invasive technique and paraverteval approach for the treatment of thoracolumbar burst fractures with none of nerve injury. Percutaneous minimally invasive technique can improve lumbodorsal pain , however, which lead to longer operative time and accepted X-ray irradiation time.%目的：对比开放性椎旁入路与经皮微创治疗无神经症状胸腰段爆裂性骨折的临床疗效。方法76例无神经症状胸腰段爆裂性骨折患者，随机分为开放组（O组，38例）及经皮微创组（P组，38例）。采用后凸Cobb角及椎体前缘高度进行影像学评估，采用疼痛视觉评分（Visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）进行临床功能评估。结果两组Cobb角、椎体前缘高度比较无统计学差异（P＞0.05），但是术后较术前都有明显改善（P＜0.01）。术后第1天，P组VAS评分较O组改善较明显（P＜0.05）；两组术前、术后3、6和12个月的VAS评分差异均无统计学意义（P＞0.05）。O组术后第1天、3月、6月、12月，疼痛改善率为57%、65%、77%、80%；P组术后第1天、3月、6月、12月，疼痛改善率为68%、75%、74%、80%。 ODI方面，两组术前、术后3、6和12个月之间差异均无统计学意义（P＞0.05）；O组术后3、6、12个月改善率分别为61%、69%、83%；P组改善率分别为57%、74%、79%。结论椎旁入路及经皮微创技术治疗无神经症状胸腰椎爆裂性骨折疗效较好，后者术后短期腰背部疼痛改善较为明显，但操作较为繁琐，手术时间较长，术者及患者接受X线照射时间长。