两种微创复位内固定手术治疗胸腰椎骨折的临床效果对比

摘要

Objective To observe and compare clinical effect of Sextant percutaneous pedicle screws fixation and minimally invasive internal fix-ation by endoscope. Methods 80 cases of thoracolumbar fracture with no neurological damage from February 2003 to February 2012 in our hospital was randomly divided into group A(40 cases) and group B(40 cases). The patients in group A were treated with Sextant percutaneous pedicle screws fixation, and in group B were treated with minimally invasive internal fixation by endoscope. The related perioperative indicators, radiographic observation and VAS score were compared. Results The operation time of group A was significantly shorter than that of group B, blood loss of group A was significantly less than that of group B, and there were significant differences (P<0.05). The hospital time and surgical incision length between the two groups had no statistically differ-ence (P>0.05). The postoperative Copp angle of group A was significantly less than group B. The correction degree of the fracture vertebral body of group A was better than group B, but the loss of anterior height of the fracture vertebral body of group A was significantly greater than that of group B (P<0.05). The postoperative sagittal index in 2 groups was basically similar. The postoperative VAS of group A was less than group B (P<0.05). Conclusion Sextant percutaneous pedicle screws fixation and minimally invasive internal fixation by endoscope had its own advantages and disadvantages. Comparing with mini-mally invasive internal fixation by endoscope, the operation of Sextant percutaneous pedicle screws fixation was more simple, less blood loss, less operative time, and could better maintain the anterior height of the fracture vertebral body.%目的：比较Sextant系统经皮椎弓根螺钉内固定与内窥镜辅助下椎弓根螺钉内固定治疗胸腰椎骨折的临床效果。方法将2003年2月至2012年2月确诊为无神经功能损伤的80例单节段胸腰椎骨折患者随机分为A组与B组，每组40例。A组采用Sextant系统经皮椎弓根螺钉内固定治疗，B组采用内窥镜辅助下椎弓根螺钉内固定治疗。比较两组在围手术期中各项指标、影像学观察结果以及VAS评分。结果 A组手术时间显著短于B组，术中出血量也显著少于B组，均具统计学差异（P<0.05），组间住院时间与手术切口长度无统计学差异（P>0.05）；A组术后Copp角显著小于B组，术后椎前缘高度矫正程度优于B组，但丢失量显著大于B组（P<0.05），A、B两组术后矢状面指数基本相近；A组术后VAS分数明显低于B组（P<0.05）。结论 Sextant系统经皮椎弓根螺钉内固定术与内窥镜辅助下椎弓根螺钉内固定术均具有其各自的优缺点，但Sextant系统经皮椎弓根螺钉内固定相对而言，操作简单，可减少术中出血量与手术时间，更好地维持伤椎前缘高度。