Zhang Wei, Li Haiyin, Zhou Yue, Wang Jian, Chu Tongwei, Zheng Wenjie, Chen Bin, Li Changqing
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
Spine (Phila Pa 1976). 2016 Oct;41 Suppl 19:B23-B29. doi: 10.1097/BRS.0000000000001814.
Prospective randomized cohort study.
To compare the surgical results of minimally invasive posterior decompression combined with percutaneous pedicle screws fixation (minimally invasive surgery [MIS]) and posterior open surgery (OS) for the treatment of thoracolumbar fracture with neurological deficits.
Thoracolumbar fracture with neurological deficits usually undergoes surgical intervention. OS can achieve satisfied results, but the main disadvantage is approach-related complications. No study, however, focused on the treatment of this disease by MIS through posterior approach.
Sixty consecutive cases of thoracolumbar fractures with neurological deficits were randomized into MIS group and OS group. Incision length, blood loss, postoperative drainage volume, hospitalization days, blood transfusion rate, analgesic use rate, and x-ray exposure time were used to evaluate the perioperative information and Visual Analog Scale (VAS), Japanese Orthopedics Association (JOA) score, and American Spinal Injury Association grade for patients' symptom. For radiological assessment, sagittal Cobb angle, percentage of vertebral height, and vertebral wedging angle were measured.
Fifty-nine of sixty patients were followed-up for at least 12 months. MIS group was superior in perioperative information (P < 0.05), except in the operative time (P = 0.165) and x-ray time (P = 0.000). The operative time seemed longer in MIS group, but no significant difference was found. The x-ray time was significantly higher in MIS group. The mean Visual Analog Scale and Japanese Orthopedics Association scores of the final follow-up in MIS group were better than that in OS group (P < 0.05). Patients in both group achieved a similar neurological recovery according to American Spinal Injury Association grade (P = 0.760). A broken screw was found in one patient in MIS group and a broken rod in one patient in OS group.
MIS group has achieved the similar effect of OS group and it can minimize the approach-related complication. It also faced with some shortages, such as larger radiation dose and longer learning curve.
前瞻性随机队列研究。
比较微创后路减压联合经皮椎弓根螺钉固定术（微创手术[MIS]）与后路开放手术（OS）治疗伴有神经功能缺损的胸腰椎骨折的手术效果。
伴有神经功能缺损的胸腰椎骨折通常需要手术干预。开放手术能取得满意的效果，但其主要缺点是与手术入路相关的并发症。然而，尚无研究关注通过后路入路的微创手术治疗该疾病。
将60例连续的伴有神经功能缺损的胸腰椎骨折患者随机分为微创手术组和开放手术组。采用切口长度、失血量、术后引流量、住院天数、输血率、镇痛药物使用率和X线暴露时间来评估围手术期信息，并采用视觉模拟评分法（VAS）、日本骨科协会（JOA）评分以及美国脊髓损伤协会分级来评估患者症状。对于影像学评估，测量矢状面Cobb角、椎体高度百分比和椎体楔形变角度。
60例患者中有59例至少随访了12个月。微创手术组在围手术期信息方面更具优势（P<0.05），但手术时间（P = 0.165）和X线暴露时间（P = 0.000）除外。微创手术组的手术时间似乎更长，但未发现显著差异。微创手术组的X线暴露时间显著更长。微创手术组末次随访时的平均视觉模拟评分和日本骨科协会评分均优于开放手术组（P<0.05）。根据美国脊髓损伤协会分级，两组患者的神经功能恢复情况相似（P = 0.760）。微创手术组有1例患者出现螺钉断裂，开放手术组有1例患者出现棒材断裂。
微创手术组取得了与开放手术组相似的效果，并且可以将与手术入路相关的并发症降至最低。它也存在一些不足——比如辐射剂量较大和学习曲线较长。
2级。
