经皮微创与传统开放椎弓根螺钉内固定治疗老年胸腰段脊柱压缩性骨折患者的对比研究

Comparison between percutaneous minimally invasive surgery and conventional open pedicle screw fixation for treatment of compression fracture of thoraco-lumbar spine in the elderly

摘要:

目的 对比经皮微创与传统开放椎弓根螺钉内固定技术治疗老年胸腰段脊柱压缩性骨折患者的疗效。方法 入选2013年6月至2017年2月解放军总医院海南分院骨科收治的老年胸腰段脊柱压缩骨折患者245例。依据手术方式分为2组:微创手术组(n=126)和传统手术组(n=119)。比较2组患者的手术时间、住院时间、术中出血量、住院费用、切口长度等围术期参数。术后随访至少6个月并测量伤椎前缘高度、Cobb角和矢状位指数。采用SPSS 18.0软件进行数据处理。依据数据类型,组间比较分别采用t检验或χ²检验。结果 与传统手术组患者相比,微创手术组患者的手术时间[(95.2±16.3) vs(126.5±39.0)min]和住院时间[(10.8±4.0) vs(22.5±13.6)d]显著缩短,术中出血量[(82.7±39.9) vs(327.2±143.1)ml]、术后引流量[(33.5±15.8) vs(301.5±110.8)ml]、住院费用[(5.1±0.3)×10⁴ vs(5.7±0.2)×10⁴ RMB yuan]和切口长度[(9.3±0.6) vs(12.8±1.9)cm]也显著减小,差异均有统计学意义(均P<0.05)。与手术前相比,2组患者手术后的伤椎椎体前缘高度[微创手术组:(11.2±7.3) vs(20.1±3.3)mm；传统手术组:(12.2±7.6) vs(21.7±2.4)mm]、Cobb角[微创手术组:(14.0±6.8)° vs(4.3±1.8)°；传统手术组:(14.8±7.0)° vs(4.6±2.8)°]和矢状位指数[微创手术组:(64.5±12.6)% vs(93.8±13.9)%；传统手术组:(63.8±13.8)% vs(95.0±9.6)%]均得到显著改善(均P<0.05)。结论 与传统开放椎弓根螺钉内固定技术相比,采用经皮微创椎弓根螺钉内固定治疗老年胸腰段脊柱压缩性骨折患者的疗效确切,且手术时间短、住院时间短、手术切口小、术中出血量少和住院费用少,值得临床推广。

Abstract:

Objective To compare the efficacy of percutaneous minimally invasive surgery and conventional open pedicle screw fixation for treatment of compression fracture of thoracolumbar spine in the elderly. Methods A total of 245 patients with compression fracture of thoracolumbar spine were enrolled in this study, who received the surgery in the Hainan Branch of Chinese PLA General Hospital from June 2013 to February 2017. They were divided into percutaneous minimally invasive surgery (PMIS) group (n=126) and open surgery (OS) group (n=119). The two groups were compared in the perioperative parameters, such as operation duration, length of hospital stay, hospitalization cost, intraoperative bleeding and incision length. The patients were followed up for at least 6 months and the anterior height of injured vertebral body, Cobb angle and sagittal index were measured. Data were analyzed using SPSS statistics 18.0. Depending on the data type, t-test or χ² test were used for comparison. Results Compared with OS group, PMIS group had significantly decreased operation duration[(95.2±16.3) vs(126.5±39.0)min], length of hospital stay[(10.8±4.0) vs(22.5±13.6)d], intraoperative bleeding[(82.7±39.9) vs(327.2±143.1)ml], postoperative drainage [(33.5±15.8) vs (301.5±110.8) ml], hospitalization cost [(5.1±0.3) vs(5.7±0.2)×10⁴ RMB yuan], and incision length [(9.3±0.6) vs(12.8±1.9)cm]. The differences were statistically significant (P<0.05 for all). Postoperative parameters were significantly improvedin both groups:anterior height of injured vertebrae [PMIS group:(11.2±7.3) vs(20.1±3.3) mm; OS group:(12.2±7.6) vs(21.7±2.4)mm], Cobb angle [PMIS group:(14.0±6.8)° vs(4.3±1.8)°; OS group:(14.8±7.0)° vs(4.6±2.8)°], and sagittal index [PMIS group:(64.5±12.6)% vs(93.8±13.9)%; OS group:(63.8±13.8)% vs(95.0±9.6)%] (P<0.05 for all). Conclusion Percutaneous minimally invasive surgery has better efficacy for treatment of compression fracture of thoracolumbar spine in the elderly than conventional open pedicle screw fixation with decreased operation duration, length of hospital stay, intraoperative bleeding, incision length and hospitalization cost. The procedure is therefore worthy of clinical promotion.