微创与开放方案置入椎弓根螺钉内固定修复胸腰椎骨折.doc

微创与开放方案置入椎弓根螺钉内固定修复胸腰椎骨折彭小忠，肖侃侃柳州市工人医院脊柱外科，广西壮族自治区柳州市 545005Minimally invasive versus open pedicle screw fixation for repair of thoracolumbar fracturesPeng Xiao-zhong, Xiao Kan-kanDepartment of Spine Surgery, Liuzhou Workers Hospital, Liuzhou 545005, Guangxi Zhuang Autonomous Region, China摘要 背景：近年来微创技术理念越来越受到重视，一些新的微创方法被运用到脊柱骨折治疗中，对旧的开放式手术治疗方法提出了挑战。目的：对比观察常规后路开放经伤椎椎弓根螺钉内固定、微创内固定方式(利用Quadrant通道内固定和经皮Sextant内固定)治疗单节段无神经症状胸腰椎骨折的临床疗效。方法：纳入2012年1月至2013年1月于柳州市工人医院脊柱外科住院并接受内固定修复治疗的94例单节段无神经症状胸腰椎骨折患者，根据患者病情及意愿分为开放内固定组、Quadrant通道内固定组及经皮Sextant内固定组，观察并比较各组患者的围手术期参数、临床疗效及影像学检查指标。 结果与结论：Quadrant通道内固定组、经皮Sextant内固定组在术中出血量、手术切口长度、住院时间方面均优于常规后路开放内固定组(P 0.05)。94例患者均获得随访，随访时间为6个月，无脱钉、断钉及神经损伤现象。3组伤椎内固定后椎体前缘高度、Cobbs角、矢状位指数与内固定前相比较均有明显改善(P 0.05)。两微创组内固定后目测类比评分、Oswestry功能障碍指数均优于常规开放内固定组(P 0.05)。提示与传统的开放内固定相比，微创(经皮Sextant内固定及利用Quadrant通道内固定)治疗胸腰椎骨折不仅能取得与之相当的影像学效果，而且具有创伤小、出血少、恢复快、安全性高的优点，有更好的临床疗效。在严格掌握手术适应证情况下，微创方法是治疗无神经损伤胸腰椎骨折的理想选择。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：窗体顶端关键词 ： 植入物； 脊柱植入物； 伤椎； 内固定； 对照研究； 椎弓根螺钉； Sextant内固定； Quadrant通道； Abstract： BACKGROUND: Recently, minimally invasive techniques obtained more attention. Some new minimally invasive methods have been used in the treatment of spine fracture and provide new challenges for conventional open surgery. OBJECTIVE: To discuss the clinical efficacy of conventional posterior open pedicle screw fixation versus minimally invasive operation (using Mast Quadrant System and Sextant percutaneous pedicle screw fixation) for treating single-segment thoracolumbar fractures without neurological damages. METHODS: A total of 94 cases of single-segment thoracolumbar fracture without neurological damages, who were treated in Department of Spine Surgery, Liuzhou Workers Hospital in China from January 2012 to January 2013, were enrolled in this study. According to patients conditions and willing, they were divided into open fixation group, Quadrant fixation group and percutaneous Sextant fixation group. Perioperative index, clinical efficacy, and imaging results were observed and compared among different groups. RESULTS AND CONCLUSION: Intraoperative blood loss, incision length and length of stay were better in the Quadrant fixation group and percutaneous Sextant fixation group than in the posterior open fixation group (P 0.05). A total of 94 patients were followed up for 6 months. No cases of nerve damage, slippage or breakage of implants were found. The anterior vertebral body height, Cobbs angle, and sagittal index were significantly improved postoperatively compared to pre-operation in all three groups (P 0.05). Postoperative Visual Analog Scale scores and Oswestry Disability Index were better in the two minimally invasive groups than in the conventional open fixation group (P 0.05). These results suggested that compared with conventional open operation, minimally invasive operation (Mast Quadrant System and Sextant percutaneous pedicle screw fixation) in the treatment of thoracolumbar fractures not only can achieve similar imaging result, but has small incision, less blood loss, quick recovery, high safety, and obtains good clinical therapeutic outcomes. In the case of strict surgical indications, minimally invasive method is an ideal choice in treating thoracolumbar fractures without neurological damages.中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：Key words： spinal fractures; surgical procedures, minimally invasive; internal fixators; pain measurement; 窗体底端 中图分类号:R318 通讯作者: 肖侃侃，在读博士，医师，柳州市工人医院脊柱外科，广西壮族自治区柳州市 545005 作者简介: 彭小忠，男，1968年生，广西壮族自治区资源县人，汉族，1993年广西医科大学毕业，副主任医师，主任，主要从事脊柱疾病外科治疗。引用本文: 彭小忠,肖侃侃. 微创与开放方案置入椎弓根螺钉内固定修复胸腰椎骨折J. 中国组织工程研究, 2014, 18(26): 4212-4218. Peng