Wang Bowen, Fan Yong, Dong Jingjing, Wang Hu, Wang Faqi, Liu Zhichen, Liu Haoyuan, Feng Yafei, Chen Fengrong, Huang Zheyuan, Chen Ruisong, Lei Wei, Wu Zixiang
Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi Department of Orthopedics, Chenggong Hospital Affiliated to Xiamen University (the 174 Hospital of PLA), Xiamen, Fujian Department of Orthopedics, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine Lintong Aeromedical Evaluation and Training Center of Chinese Airforce, Xi'an, Shaanxi, China.
Medicine (Baltimore). 2017 Sep;96(38):e8104. doi: 10.1097/MD.0000000000008104.
The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation for treating thoracolumbar fractures with spinal injuries.
A total of 105 patients with thoracolumbar fractures and spinal injuries were divided into a percutaneous pedicle screw fixation (PPSF) group with 56 patients, who underwent percutaneous pedicle screw fixation, and an open pedicle screw fixation (OPSF) group with 49 patients, who underwent open pedicle screw fixation in accordance with the treatment project. Relative operation indexes, radiologic, and effectiveness parameters were assessed and compared between the 2 groups.
Demographic and clinical features including age, body mass index, gender, fracture level, fracture classification, and Frankel grade in both groups were not significantly different (all P >.05). The PPSF group exhibits significantly lower operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay on average compared with the OPSF group (all P < .05). Besides, the average postoperative radiologic parameters, including Cobb angle (CA), vertebral wedge angle (VWA), vertebral front height percentage (VFHP), and sagittal index (SI), in both the groups were not significantly different (all P > .05). Nevertheless, both visual analogue scale (VAS) and Oswestry disability index (ODI) after surgery decreased more substantially in the PPSF group than in the OPSF group (all P < .05) while no significant difference in VAS scores or ODI during the last follow-up period was demonstrated in both the groups (both P > .05). Frankel classifications were stimulated in both the groups during the last follow-up period.
PPSF has a smaller incision, less intraoperative blood loss, shorter recovery time, higher safety measures on average compared with OPSF with respect to managing thoracolumbar fractures with spinal injuries.
本研究旨在评估经皮椎弓根螺钉固定术与切开椎弓根螺钉固定术治疗伴有脊髓损伤的胸腰椎骨折的有效性。
将105例伴有脊髓损伤的胸腰椎骨折患者分为经皮椎弓根螺钉固定术(PPSF)组56例,行经皮椎弓根螺钉固定术;切开椎弓根螺钉固定术(OPSF)组49例,按治疗方案行切开椎弓根螺钉固定术。评估并比较两组的相关手术指标、影像学及有效性参数。
两组患者的人口统计学和临床特征,包括年龄、体重指数、性别、骨折节段、骨折分类及Frankel分级,差异均无统计学意义(均P>.05)。与OPSF组相比,PPSF组平均手术时间、术中出血量、术后引流量及住院时间均显著降低(均P<.05)。此外,两组术后平均影像学参数,包括Cobb角(CA)、椎体楔角(VWA)、椎体前缘高度百分比(VFHP)及矢状指数(SI),差异均无统计学意义(均P>.05)。然而,PPSF组术后视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)下降幅度均明显大于OPSF组(均P<.05),而两组末次随访时VAS评分及ODI差异均无统计学意义(均P>.05)。两组末次随访时Frankel分级均有改善。
与OPSF相比,PPSF治疗伴有脊髓损伤的胸腰椎骨折切口更小、术中出血更少、恢复时间更短,平均安全措施更高。