杜绍欢 陈万安

【摘要】 目的：探究經皮椎弓根内固定在无神经损伤胸腰椎骨折中的疗效及对脊柱稳定性的影响。方法：将2021年10月—2023年1月汕头市澄海区人民医院收治的82例无神经损伤胸腰椎骨折患者根据随机数字表法分为对照组（n=41）和观察组（n=41）。对照组进行开放椎弓根内固定治疗，观察组进行经皮椎弓根内固定治疗。比较两组优良率、手术时间、切口长度、术中出血量、住院时间、并发症发生率，以及手术前后的疼痛程度[语言分级评分法（VRS）]和脊柱稳定性（伤椎前、后缘高度比、矢状面指数及后凸Cobb角）。结果：两组优良率比较，差异无统计学意义（P>0.05）；观察组的手术时间、住院时间及切口长度均显著短于对照组，术中出血量显著少于对照组，并发症发生率显著低于对照组，差异均有统计学意义（P<0.05）；术前两组VRS评分及脊柱稳定性指标比较，差异均无统计学意义（P>0.05）；术后1、4、12周，观察组的VRS评分均显著低于对照组，差异均有统计学意义（P<0.05）；两组术后24周的VRS评分及术后12、24周的脊柱稳定性指标比较，差异均无统计学意义（P>0.05）。结论：经皮椎弓根内固定可减轻手术创伤，有效促进无神经损伤胸腰椎骨折患者的术后恢复，疗效确切，对脊柱稳定性的效果与开放手术相近。

【关键词】 经皮椎弓根内固定 胸腰椎骨折 脊柱稳定性

Effect of Percutaneous Vertebral Pedicle Internal Fixation on Thoracic and Lumbar Spine Fracture without Nerve Injury and Its Influence on Spinal Stability/DU Shaohuan， CHEN Wanan. //Medical Innovation of China， 2024， 21（07）： 00-005

[Abstract] Objective： To investigate the effect of percutaneous vertebral pedicle internal fixation on thoracic and lumbar spine fracture without nerve injury and its influence on spinal stability. Method： A total of 82 patients with thoracic and lumbar spine fracture without nerve injury admitted to People's Hospital of Chenghai Shantou from October 2021 to January 2023 were divided into control group （n=41） and observation group （n=41） according to random number table method. The control group was treated with open vertebral pedicle internal fixation and the observation group was treated with percutaneous vertebral pedicle internal fixation. The excellent and good rate， operative time， incision length， intraoperative bleeding volume， hospital stay， complication rate and pain degree [verbal rating scale （VRS）] and spinal stability （anterior and posterior margin height ratio of injured vertebra， sagittal plane index and kyphotic Cobb angle） before and after surgery were compared between the two groups. Result： There was no significant difference in the excellent and good rate between the two groups （P>0.05）. The operation time， hospital stay and incision length in the observation group were significantly shorter than those in the control group， the intraoperative bleeding volume was significantly less than that in the control group， and the incidence of complications was significantly lower than that in the control group， the differences were statistically significant （P<0.05）. There were no significant differences in VRS scores and spinal stability indexes between the two groups before surgery （P>0.05）. At 1 week and 4， 12 weeks after surgery， the VRS scores of observation group were significantly lower than those of control group， the differences were statistically significant （P<0.05）. There were no significant differences between the two groups in VRS scores at 24 weeks after surgery and spinal stability indexes at 12 and 24 weeks after surgery （P>0.05）. Conclusion： Percutaneous vertebral pedicle internal fixation can reduce surgical trauma and effectively promote postoperative recovery of patients with thoracic and lumbar spine fracture without nerve injury. The efficacy is accurate， and the effect on spinal stability is similar to that of open surgery.

[Key words] Percutaneous vertebral pedicle internal fixation Thoracic and lumbar spine fracture Spinal stability

First-author's address： Orthopaedic Center， People's Hospital of Chenghai Shantou， Shantou 515800， China

doi：10.3969/j.issn.1674-4985.2024.07.001

胸腰椎骨折是临床中较为严重的骨折类型，其中无神经损伤的胸腰椎骨折，虽然治疗难度相对更低，预后相对较好，但是其疗效提升的需求仍较高，而治疗后脊柱稳定性的提升，也是预后改善的重要基础与前提[1-2]。既往临床关于无神经损伤胸腰椎骨折的手术治疗研究多见，其中椎弓根内固定是常用且效果较好的手术方式之一，而关于开放与经皮椎弓根内固定的比较性研究虽多见，但是其结果差异仍存在[3-5]，同时上述手术方式对患者脊柱稳定性的研究不足。鉴于……