经皮与经椎旁肌间隙入路椎弓根螺钉内固定术治疗胸腰段椎体骨折患者的疗效及对手术创伤应激的影响<sup>*</sup>

doi:10.3969/j.issn.1671-7171.2025.07.011

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摘要【目的】探讨经皮与经椎旁肌间隙入路椎弓根螺钉内固定术治疗胸腰段椎体骨折患者的疗效及对手术创伤应激的影响。【方法】选取2019年1月至2022年10月在本院接受治疗的124例胸腰段椎体骨折患者,按照随机数字表法分为椎旁肌组(采用经椎旁肌间隙入路椎弓根螺钉内固定术治疗)、经皮组(采用经皮入路椎弓根螺钉内固定术治疗),每组62例。比较两组手术指标、视觉模拟评分法(VAS)评分、创伤因子[皮质醇(Cor)、白细胞介素-8(IL-18)、C反应蛋白(CRP)]水平、影像学指标(椎矢状面指数、后凸Cobb角)、功能恢复指标[Oswestry功能障碍指数(ODI)、Barthel指数(BI)]及并发症发生情况。【结果】经皮组手术时间长于椎旁肌组,透视次数多于椎旁肌组,手术切口长度、术中出血量、住院时间均优于椎旁肌组(P<0.05)。两组术后1周椎体复位率均为100.00%。术后3 d、1周,经皮组VAS评分低于椎旁肌组(P<0.05),血清Cor、IL-18、CRP水平均低于椎旁肌组(P<0.05)。术后3 d、3个月、1年,两组伤椎矢状面指数、后凸Cobb角比较,差异无统计学意义(P>0.05)。术后1个月,经皮组ODI评分低于椎旁肌组(P<0.05),BI评分高于椎旁肌组(P<0.05);术后1年,两组ODI、BI评分比较,差异无统计学意义(P>0.05)。经皮组并发症总发生率为9.68%,与椎旁肌组的14.52%比较,差异无统计学意义(P>0.05)。【结论】经皮和经椎旁肌间隙入路椎弓根螺钉内固定术治疗胸腰段椎体骨折患者疗效确切,且均安全可靠。前者创伤小,手术精密度高,但手术时间长、透视次数多,操作者需具备丰富的开放手术和微创手术经验;后者操作简单,但切口长,术后早期康复相对缓慢。

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关键词 ：脊柱骨折, 骨折固定术,内, 胸椎, 腰椎

Abstract：【Objective】To explore the efficacy of percutaneous and trans-paraspinal muscle space approaches for pedicle screw fixation in the treatment of thoracolumbar vertebral fractures and their impact on surgical traumatic stress.【Methods】A total of 124 patients with thoracolumbar vertebral fractures treated in our hospital from January 2019 to October 2022 were selected and randomly divided into the paraspinal muscle group (treated pedicle screw fixation via paraspinal muscle space approach) and the percutaneous group (treated pedicle screw fixation via percutaneous approach), with 62 cases in each group. The surgical indicators, visual analogue scale (VAS) scores, traumatic factors [cortisol (Cor), interleukin-8 (IL-8), C-reactive protein (CRP)], radiological imaging indicators (kyphotic Cobb angle and sagittal vertebral index), functional recovery parameters [Oswestry Disability Index (ODI) and Barthel Index (BI)], and complication rates were compared between the two groups.【Results】The operation time of the percutaneous group was longer than that of the paraspinal muscle group, and the number of fluoroscopies was more than that of the paraspinal muscle group. The incision length, intraoperative blood loss, and hospital stay of the percutaneous group were better than those of the paraspinal muscle group (P<0.05). The vertebral body reduction rate was 100.00% in both groups one week after surgery. At 3 days and 1 week after surgery, the VAS score of the percutaneous group was lower than that of the paraspinal muscle group (P<0.05), and the levels of serum Cor, IL-8, and CRP were lower than those of the paraspinal muscle group (P<0.05). At 3 days, 3 months, and 1 year after surgery, there was no significant difference in the sagittal vertebral index and kyphotic Cobb angle between the two groups (P>0.05). At 1 month after surgery, the ODI of the percutaneous group was lower than that of the paraspinal muscle group (P<0.05), and the BI was higher than that of the paraspinal muscle group (P<0.05). At 1 year after surgery, there was no significant difference in both ODI and BI between the two groups (P>0.05). The total complication rate of the percutaneous group was 9.68%, which was not significantly different from 14.52% of the paraspinal muscle group (P>0.05).【Conclusion】Both percutaneous and paraspinal muscle space approaches for pedicle screw fixation in the treatment of thoracolumbar vertebral fractures are effective, safe, and reliable. However, the former has less trauma, higher surgical precision, and greater difficulty, with longer operation time and more fluoroscopy. The operator requires rich experience in open surgery and minimally invasive surgery. The latter has simpler surgical operation, but longer incision and relatively slower early postoperative recovery.

Key words： Spinal Fractures Fracture Fixation, Internal Thoracic Vertebrae Lumbar Vertebrae

收稿日期: 2025-02-05

中图分类号:

R683.2

基金资助:^*承德市科学技术研究与发展计划项目(202102A012)

通讯作者: ^**E-mail:syb82008@163.com

引用本文:

徐文硕, 陈申跳, 关艳, 孙铭霞, 孙彦豹. 经皮与经椎旁肌间隙入路椎弓根螺钉内固定术治疗胸腰段椎体骨折患者的疗效及对手术创伤应激的影响^*[J]. 医学临床研究, 2025, 42(7): 1141-1145.
XU Wenshuo, CHEN Shentiao, GUAN Yan, et al. Investigation of the Effect of Minimally Invasive Arch Nailing Technique Access Selection on Vertebral Fractures in the Thoracolumbar Segment. JOURNAL OF CLINICAL RESEARCH, 2025, 42(7): 1141-1145.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2025.07.011 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2025/V42/I7/1141

[1] SPIEGL U J, FISCHER K, SCHMIDT J, et al. The conservative treatment of traumatic thoracolumbar vertebral fractures[J].Dtsch Arztebl Int,2018,115(42):697-704.
[2] LI H M, ZHANG R J, GAO H, et al. New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA[J].Medicine (Baltimore),2018,97(40):12666.
[3] KAPOEN C, LIU Y, BLOEMERS F W, et al. Pedicle screw fixation of thoracolumbar fractures: conventional short segment versus short segment with intermediate screws at the fracture level-a systematic review and meta-analysis[J].Eur Spine J,2020,29(10):2491-2504.
[4] KOCIS J, KELBL M, KOCIS T, et al. Percutaneous versus open pedicle screw fixation for treatment of type A thoracolumbar fractures[J].Eur J Trauma Emerg Surg,2020,46(1):147-152.
[5] 易大莉.临床试验样本量交互式估计的图视化研究[D].重庆:中国人民解放军陆军军医大学,2017.
[6] CHIAROTTO A, MAXWELL L J, OSTELO R W, et al. Measurement properties of visual analogue scale, numeric rating scale, and pain severity subscale of the brief pain inventory in patients with low back pain: a systematic review[J].J Pain,2019,20(3):245-263.
[7] 程继伟,王振林,刘伟,等.Oswestry功能障碍指数的改良及信度和效度检验[J].中国脊柱脊髓杂志,2017,27(3):235-241.
[8] 侯东哲,张颖,巫嘉陵,等.中文版Barthel指数的信度与效度研究[J].临床荟萃,2012,27(3):219-221.
[9] ZHAO Q P, ZHANG H P, HAO D J, et al. Complications of percutaneous pedicle screw fixation in treating thoracolumbar and lumbar fracture[J].Medicine (Baltimore),2018,97(29):1156-1162.
[10] HUANG Z H, TONG Y X, FAN Z Y, et al. Percutaneous pedicle screw fixation combined with selective transforaminal endoscopic decompression for the treatment of thoracolumbar burst fracture[J].J Orthop Surg Res,2020,15(1):415-421.
[11] 周红艳,刘光源,刘金辉,等.艾司唑仑对全髋关节置换术后患者疼痛和早期康复的影响[J].河北医药,2021,43(10):1513-1516.
[12] 闫琦,安海燕,冯艺. 健康志愿者清醒时疼痛程度与镇痛伤害感受指数相关性研究[J].中国疼痛医学杂志,2020,26(3):185-190.
[13] 袁静,孙榕芳,张占东.腹腔镜手术治疗结直肠癌患者的近期疗效及对机体应激反应的影响[J].癌症进展,2022,20(24):2523-2526.
[14] 张宝强,郭峰,张小栋,等. 不同入路椎弓根钉治疗胸腰椎段脊柱骨折的临床效果比较[J].临床医学研究与实践,2022,7(17):51-54.
[15] 胡巍然,吴肖南,施新革,等.微创经椎间孔入路腰椎融合术后融合节段和邻近节段椎旁肌退变及其与患者生活质量的相关性分析[J].中华创伤骨科杂志,2022,24(10):910-915.