关键词: 经皮微创入路手术, 开放手术, 腰椎骨折, 临床疗效

Abstract: Objective To compare the clinical effect of percutaneous minimally invasive surgery with open surgery for lumbar fracture.Methods A total of 62 patients with thoracolumbar fracture who received surgical intervention in our hospital from April 2018 to April 2022 were selected and divided into percutaneous minimally invasive approach group and traditional open group according to random number table method,with 31 cases in each group.Patients in the traditional open group were treated with open surgery,that is,traditional open internal fixation,and patients in the percutaneous minimally invasive approach group were treated with minimally invasive percutaneous approach.Surgical indexes such as operation time,incision length,intraoperative blood loss,length of hospital stay and so on were compared between the two groups.Visual Analog Scale (VAS) scores of the two groups were observed 1,3 and 7 days after surgery.Changes in ESR and D-dimer factor indexes before and after surgery were compared between the two groups.The vertebral space height,kyphotic Cobb Angle imaging indicators before and after surgery were compared between the two groups,and the total incidence of postoperative complications was compared between the two groups.Results The surgical time, incision length,intraoperative bleeding volume,and hospital stays of the minimally invasive percutaneous approach group were (65.25±13.76) minutes, (8.31±1.44) cm, (91.37±11.09) ml and (8.59±1.35)d,respectively,which were significantly lower than those of the traditional open group [(110.37±20.43) minutes, (13.17±2.02) cm, (475.38±18.36) ml, and (11.93±2.91) d] (all P<0.05).The postoperative VAS scores of both groups of patients gradually decreased with time (P<0.05), but the VAS scores of the percutaneous minimally invasive approach group on the 1st day (7.12±1.13), 3rd day (3.27±0.75), and 7th day (2.47±0.78) after surgery were significantly lower than those of the traditional open group (8.36±1.64, 5.48±1.27, 4.26±1.36) (all P<0.05).Three days after surgery, two groups of serum factors including erythrocyte sedimentation rate (ESR), and D-dimer (D-D) levels were significantly higher than before surgery, but the levels of various indicators in the minimally invasive percutaneous approach group were significantly lower than those in the traditional open group (all P<0.05).Seven days after surgery, the height of the intervertebral space (92.66±5.72 vs 83.17±5.04) and the kyphotic Cobb angle (7.37±2.85 vs 9.72±3.18) in the minimally invasive percutaneous approach group were significantly higher than those in the traditional open group (all P<0.05).The total incidence of complications in the minimally invasive percutaneous approach group was significantly lower than that in the traditional open group (6.45% vs 35.48%)  (P<0.05). Conclusion For lumbar patients,the application of minimally invasive percutaneous approach has positive effects on promoting rapid postoperative recovery,reducing pain and reducing the risk of postoperative complications.

Key words: percutaneous minimally invasive approach, open surgery, lumbar spine fracture, clinical efficacy