经皮椎弓根螺钉联合伤椎两种置钉方式治疗胸腰椎骨折的比较

Comparison of Two Percutaneous Pedicle Screw Placement in the Injured Vertebra for Thoraclumbar Fractures

摘要: 目的：对比经皮椎弓根螺钉联合伤椎万向钉与伤椎固定钉治疗胸腰椎骨折的近期临床疗效。方法：回顾性分析合肥市第二人民医院在2016年5月至2022年3月期间收治的单节段无神经损伤的胸腰椎骨折患者共42例，所有患者均采用经伤椎短节段微创经皮椎弓根螺钉内固定手术治疗。22例患者伤椎及邻椎均采用万向钉(对照组)；20例患者伤椎采用单向钉，邻椎采用万向钉(实验组)。比较两组患者的手术时间、术中出血量、住院时间，术前、术后、末次随访的VAS评分、伤椎椎体前缘高度比值、伤椎后凸角及矢状位cobb角。结果：随访时间8~12个月。两组住院时间、手术时间及术中出血量无统计学意义(P > 0.05)；两组术后及末次随访矢状位cobb角、伤椎前缘高度比、伤椎后凸角与术前对比均有统计学意义(P < 0.05)，实验组术后矢状位cobb角、伤椎后凸角优于万向钉组，且两组差异有统计学意义(P < 0.05)；两组术前及术后随访VAS评分对比无统计学意义。结论：经皮椎弓根螺钉联合伤椎单向钉与经皮全万向钉内固定术治疗胸腰椎骨折均可恢复椎体高度，但是伤椎置入单向钉可更好的维持伤椎前缘高度，纠正后凸畸形。

Abstract: Objective: to compare the recent clinical effect of percutaneous pedicle fixation of thoracolumbar fractures with monoaxial and polyaxial pedicle screw in the injured vertebra. Methods: 42 patients with thoracolumbar fracture admitted to our hospital from May 2016 to March 2022 were selected as the investigation objects, the clinical data were retrospectively analyzed. The 42 patients were divided into experimental group and control group. The experimental group was fixed with mono-axial pedicle screw in injured vertebra and polyaxial pedicle screw in adjacent vertebra. The control group was fixed with polyaxial pedicle screw in the injured vertebra and adjacent vertebra. The therapeutic effect, operation time, surgical bleeding combination, incidence of complications, im-provement rate of VAS pain score, surgical indexes and treatment satisfaction were compared be-tween the two groups. Results: The follow-up period was 8~12 months. There was no statistically significant difference between the two groups in terms of hospitalization time, operation time and intraoperative bleeding (P > 0.05); the sagittal cobb angle, the height ratio of the anterior edge of the vertebral body and vertebral compression angle were statistically significant (P < 0.05) in both groups after surgery and at the last follow-up compared with those before surgery, the sagittal cobb angle and the vertebral compression angle of the injured vertebra in the monoaxial pedicle group were smaller than those in the polyaxial pedicle group after surgery (P < 0.05), and there was no statistically significant difference in VAS score between two groups (P > 0.05). Conclusion: Percuta-neous pedicle fixation for thoracolumbar fractures with monoaxial and polyaxial pedicle screw in the injured vertebra can restore injured vertebral height, but the former one has better correction of deformity of injured vertebra.