三种不同入路手术治疗胸腰椎骨折的疗效比较

doi:10.3969/j.issn.1006-6233.2023.04.08

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Abstract Objective: To investigate the efficacy of three different approaches in the treatment of thoracolumbar fractures. Methods: The clinical data of 325 patients with thoracolumbar fractures admitted to our hospital from January 2020 to January 2021 were retrospectively analyzed. The patients treated with the posterior median approach, percutaneous approach, and paravertebral interbody approach with the pedicle nail rod system were included in groups A (n=110), B (n=108), and C (n=107), respectively, and the clinical efficacy, perioperative indexes, injured spine indexes, and prognosis of the patients in the three groups were compared. The clinical outcomes, perioperative indexes, injured spine indexes and prognosis of the three groups were compared. Results: VAS scores and ODI scores decreased in all three groups at 3 months after surgery, and the difference between the preoperative and postoperative values of patients in the three groups were compared, and the changes in groups B and C were greater than those in group A and the changes in group C were greater than those in group B. The differences in the changes in VAS scores and ODI scores in the three groups were statistically significant (P<0.05); the difference in operating time, intraoperative bleeding, hospitalization time and fracture healing time was less in groups B and C than in the control group; the incision length was shorter in group B than in groups A and C (P<0.05); the posterior convexity Cobb's angle decreased and the height of the anterior border of the injured spine increased in all three groups at 3 months after surgery. Comparing the changes in the difference between the three groups of patients before and 3 months after surgery, the changes in groups B and C were greater than those in group A and the changes in group C were greater than those in group B. There were statistically significant differences in the magnitude of changes in the posterior convex Cobb angle and the height of the anterior edge of the injured spine in the three groups (P<0.05); there were no statistically significant differences in the three-dimensional range of motion in the three groups (P>0.05); patients in all three groups had complications such as incisional infection and postoperative residual low back pain, and there were no statistically significant differences in the incidence of the three groups (P>0.05). Conclusion: The three surgical approaches have good prognosis and can improve spinal motion to some extent, but the percutaneous approach and the paravertebral interbody approach improve the efficacy, perioperative indexes and the level of injured spine indexes more significantly in patients with thoracolumbar fractures. The clinical choice of surgical approach should be targeted to enhance the therapeutic benefit.

Key words： Thoracolumbar fracture Pedicle screw Internal fixation

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2023.04.08 OR http://www.hbyxzzs.cn/EN/Y2023/V29/I4/566

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