Clinical study on the application of minimally invasive percutaneous pedicle screw fixation in single segment thoracolumbar fracture without neurological symptoms

摘要

Objective To discuss the clinical effects of minimally invasive percutaneous pedicle screw fixation in the treatment of single segment thoracolumbar fracture without neurological symptoms. Methods From June 2012 to October 2014, 38 neurologically intact patients with thoracolumbar fracture underwent surgeries, including open pedicle screw fixation in 16 cases and percutaneous pedicle screw fixation in 22 cases. The incision length, operation time, intraoperative blood loss, postoperative drainage and postoperative complication were recorded and compared between 2 groups. Thoracolumbar orthophoric, lateral and flexion-extension X-ray was used to measure sagittal Cobb angle and height of injured anterior vertebral body before and after operation. Modified Macnab evaluation was used to assess the curative effects 3 months after operation. Results The success rate of operations in 38 patients was 100%. There were a total of 114 vertebral bodies fused and 228 pedicle screws implanted. Patients in the percutaneous pedicle screw group had smaller incision length [(10.55 ± 1.23) cm vs (18.50 ± 2.50) cm, P = 0.000], less intraoperative blood loss [(32.55 ± 7.22) ml vs (320.50 ± 15.48) ml, P = 0.000], shorter hospital stay [(6.55 ± 1.50) d vs (13.50 ± 2.52) d, P = 0.000], and without postoperative drainage. The follow-up after operation ranged from 3 to 6 months, with the average time of (4.65 ± 1.24) months. Cobb angle was reduced ( P = 0.000) and height of injured anterior vertebral body were improved signifcantly ( P = 0.000) 3 months after surgery in both groups. The total effective rate was 14/16 in open surgery group, and 86.36% (19/22) in percutaneous pedicle screw group, however, the difference between 2 groups was not significant ( P = 1.000). Conclusions Minimally invasive percutaneous pedicle screw fixation is a surgical method with less?iatrogenic injury, less intraoperative blood loss and quick recovery for patients with thoracolumbar fracture. The short-term effect of percutaneous surgery is similar to open surgery, however, its long-term effect remains to be further studied. DOI: 10.3969/j.issn.1672-6731.2016.03.004