| [objective]Minimally invasive spine surgery technique(MISST) was a development trend in the spine, and patients with spinal disease can get more benefits. It had many advantages including: a small surgical trauma, less bleeding, shorter hospitalization time and short recovery and et al. Among them, minimally invasive spine technology of the percutaneous pedicle screw fixation(PPSF) had been gradually used in spine fracture, lumbar olisthe disease, osteoporosis and lumbar instability syndrome abroad. At present, only a handful of big hospitals can conduct minimally invasive spine surgery in some parts of our country. Minimally invasive percutaneous pedicle screw internal fixation surgery was a kind of new technology, and it got more and more favour in clinicians and patients.Therefore, the new technology was quickly applicated in clinic. But comparing with the traditional cut pedicle screw fixation, the curative effect was still a controversial problem. Through comparing on the clinical curative effect of these two kinds treatment, evaluating clinical curative effect of thses two kinds of surgical treatment of thoracolumbar compression fractures to provide better guidence to clinical treatment of vertebral compression fractures(VCF). [methods]80 cases with thoracolumbar compression fractures were collected. Selected standards: 1. Type A thoracolumbar fractures of the AO classification; 2. Fanterior highly compressed more than a third of the thoracolumbar fractures; 3. Without spinal cord or cauda equina nerve injury of thoracolumbar fractures. Exclusion criteria: 1. The blowout fracture or fracture dislocation, spinal canal sagittal diameter shortening of more than 30% or heavier neurological symptoms with intraoperative decompression; 2. Severe osteoporotic compression fractures; 3. Pathological fractures of vertebral bodies;4. The fractures accompanied with severe cardiopulmonary disease, blood coagulation dysfunction etc. 80 cases were divided into two groups, group A taking minimally invasive percutaneous pedicle screw fixation, group B taking the traditional open pedicle screw fixation, then comparing two groups of patients with surgery and length of hospital stay, the degree of tissue damage, blood loss, postoperative recovery(postoperative VAS pain score, the protruding after postoperative Cobb’s Angle, thoracolumbar motion and fanterior trailing edge height ratio), and the postoperative complications. Follow-up of 12 to 18 months, with an average of 15.6 months. [results]1. with 12 to 18 months follow-up of 80 patients, all patients for the first phase class of healing, patients without loosening of internal fixation, fall off, fracture, etc., and no further nerve further injury. Bleeding of minimally invasive group was109±16 ml, incision surgical patients with haemorrhage amount to 331±30 ml, with statistical significant(P < 0.05). Minimally invasive group, length of hospital stay of minimally invasive group was 8.1±1.1 days, and cut scores in patients with an average length of hospital stay of 14.2±1.4 days, with statistical significant(P < 0.05).2. Average operation time of minimally invasive group was 88.1±6.2 min and cut the surgical patients was 92.3±6.1 min, without statistical difference(P>0.05).3. The minimally invasive group and open surgical patients postoperative follow-up deformity correction difference: minimally invasive group of preoperative Cobb Angle was 20.3±1.8°,the postoperative Cobb Angle of 6.3±2.2°, and the Angle change of postoperative was 14.0±0.4°; Incision surgical patients with preoperative Cobb Angle was 19.9±2.1°, the postoperative Cobb Angle of 6.6±1.2°, the Angle change of postoperative was 13.3±0.9°.Two groups of deterrence effects are obvious, without statistical difference(P > 0.05).4. VAS pain score: VAS grade of minimally invasive group was 1-6 scores, and the average score was 1.6±0.7; Cut surgical patients with an average score of 2.6±0.6. Minimally invasive group of patients pain score was less, with statistically difference(P <0.05).5. Vertebral body damage before and after surgery: Before surgery, ratio of minimally invasive group was 47.1±1.6, postoperatively ratio was 91.8±2.3, changing of 44.7±0.7; Before surgery, ratio of Cut surgical group was 47.8±2.6, postoperatively ratio was92.4±3.3, changing of 44.6±0.7, without statistical difference(P>0.05). [conclusion]Both Minimally invasive percutaneous and traditional cut pedicle screw internal fixation can effectively treat thoracolumbar compression fractures, correcting deformity, restoring the damage. Besides these two methods had no statistical significance to the recovery of Cobb Angle. Bleeding of minimally invasive surgery was obvious less than that of open surgery, and with the small incision, small trauma, less hospital stay, faster recovery. So taking minimally invasive percutaneous pedicle screw internal fixation to treat thoracolumbar pure compression fractures was more compatable and was worthy of clinical promotion. |
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