Comparison of clinical effect of minimally invasive percutaneous and transmuscular approach space with pedicle screw internal fixation in the treatment of thoracolumbar fractures
HUANG Zhonglian1 ZHANG Nan2 ZHANG Yuantao1
1.Department of Orthopedics, the First Affiliated Hospital of Shantou University Medical College, Guangdong Province, Shantou 515041, China;
2.Department of Orthopedics, Chaonan Minsheng Hospital of Shantou City, Guangdong Province, Shantou 515100, China
Abstract：Objective To compare the clinical effect of minimally invasive percutaneous and transmuscular space approach pedicle screw internal fixation in the treatment of thoracolumbar fractures. Methods The clinical data of 100 patients with thoracolumbar fractures admitted to the First Affiliated Hospital of Shantou University Medical College from February 2017 to August 2018 were retrospectively analyzed. The selected patients were divided into minimally invasive percutaneous group (51 cases) and transmuscular space group (49 cases) according to the surgical methods. Minimally invasive percutaneous therapy was used in the minimally invasive percutaneous group, and transmuscular space therapy was used in the transmuscular space group. Functional improvement, pain, clinical efficacy, incidence of complications and imaging indexes were compared between the two groups. Results There was no statistically significant difference between the two groups in the clinical total effective rate at 6 months after surgery (P ＞ 0.05). Compared with the minimally invasive percutaneous group, the transmuscular space group had shorter operative time and fewer intraoperative fluoroscopy times. However, the intraoperative blood loss was large and the hospital stay was long, the differences were statistically significant (all P ＜ 0.05). There was no significant difference in incision length between the two groups (P ＞ 0.05). The differences in time points and interaction between the two groups were statistically significant (all P ＜ 0.05), while the differences between the two groups were not statistically significant (P ＞ 0.05). Compared with the preoperative results, visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores of the two groups were decreased at 1 week, 3 months and 6 months after surgery, and compared with 1 week after surgery, VAS and ODI scores of the two groups decreased at 3 months and 6 months after surgery, moreover, VAS and ODI scores of the two groups at 6 months after surgery were lower than those at 3 months after surgery, the differences were statistically significant (all P ＜ 0.05). There was no statistically significant difference in VAS and ODI scores between the two groups at 1 week, 3 months and 6 months after surgery (all P ＞ 0.05). Compared with the preoperative results, the anterior edge height of the injured vertebral body increased and the Cobb angle of kyphosis decreased in the two groups at 1 week and 6 months after surgery, with statistically significant differences (all P ＜ 0.05). There was no statistically significant difference in the anterior edge height of the injured vertebral body and the Cobb angle of kyphosis between the two groups at 1 week and 6 months after surgery (P ＞ 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P ＞ 0.05). Conclusion In the treatment of thoracolumbar fracture, minimally invasive percutaneous and transmuscular space approach with pedicle screw internal fixation has the same therapeutic effect. Minimally invasive percutaneous surgery has less blood loss and shorter hospital stay, but transmuscular space surgery has shorter time and less intraoperative fluoroscopy.
2020, Vol. 17 
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