探讨经皮微创入路椎弓根钉短节段复位内固定治疗无需减压的胸腰椎骨折中伤椎置钉对疗效的影响。

回顾性分析2016年3月至2019年6月期间我科共收治无需减压的胸腰椎压缩骨折患者58例，采用跨伤椎置钉短节段复位固定32例（伤椎未置钉组），其中男24例，女8例，平均年龄（45±10）岁。采用经伤椎置钉短节段复位内固定26例（伤椎置钉组），其中男20例，女6例，平均年龄（44±10）岁；对两组病例的切口长度、术中失血量、术中透视次数、手术时间、住院费用、手术前、后疼痛视觉模拟量表评分（visual analogue scale，VAS）及影像学参数、术后并发症情况进行对比分析。

所有入组病例均获得随访12~18个月，平均随访时间（15.6±1.7）个月。伤椎未置钉组与伤椎置钉组比较，手术切口更小，住院费用更低（P<0.05）；但术中出血量、X线投照次数、手术时间方面对比，无统计学差异（P>0.05）；两组间术前、术后随访时疼痛VAS评分、Oswestry disability index score，ODI）评分方面对比差异无统计学意义（P>0.05），但两组内比较，手术后均较术前明显降低（P<0.05）；两组间在术后3天、1年随访时伤椎前缘高度压缩比、后凸cobb角、方面对比差异无统计学意义（P>0.05），但两组内比较，手术后均较手术前改善明显（P<0.05）。两组间在术后1年椎体前缘高度矫正率、Cobb角矫正率方面对比，差异无统计学意义（P>0.05）。两组病例均未发生术中置钉导致神经损伤，术后感染、内固定物松动、断裂等并发症。

采用经皮微创入路椎弓根钉短节段复位内固定治疗无需减压的胸腰椎骨折，临床疗效满意，术中伤椎置钉与否对疗效无显著影响。但伤椎未置钉组与伤椎置钉组比较，手术切口更小，住院费用更低。

To investigate the effect of short-segment reduction and internal fixation with percutaneous minimally invasive pedicle screw for the treatment of thoracolumbar fractures without decompression.

From March 2016 to June 2019, 58 patients with thoracolumbar compression fractures who did not need decompression were treated in our department retrospectively. A total of 32 cases were fixed by short-segment reduction and fixation with cross-injury vertebrae (uninjured vertebrae group). 26 cases were fixed by short-segment reduction and fixation with injury vertebrae (injured vertebrae group), including 24 males and 8 females, with an average age of (45±10) years. Twenty-six cases of short-segment reduction and internal fixation (traumatic vertebral screw placement group) were used, including 20 males and 6 females, with an average age of (44±10) years. The length of the incision, intraoperative, the blood loss, the number of intraoperative fluoroscopy, operation time, hospitalization expenses, VAS (Visual Analogue Scale Score for Pain) scores before and after the operation, imaging parameters, and postoperative complications were compared and analyzed.

All the enrolled cases were followed up for 12-18 months, with an average follow-up time of 15.6±1.7 months. Compared with the injured vertebra without nail placement group, the surgical incision was smaller and the hospitalization cost was lower (P<0.05), but there was no statistical difference in intraoperative blood loss, X-ray exposure times, and operation time (P>0.05). There was no statistically significant difference in pain VAS score and ODI score between the two groups before operation and during postoperative follow-up (P>0.05), but the comparison between the two groups was significantly lower after operation than before operation (P<0.05). There was no significant difference in the compression ratio of the anterior edge of the injured vertebrae and the cobb's angle of the kyphosis at the 3 days and 1 year follow-up between the two groups (P>0.05). Compared with the pre-operation, all improved significantly afterwards (P<0.05). There was no significant difference between the two groups in the correction rate of anterior vertebral body height and the correction rate of Cobb angle at 1 year after operation (P>0.05). There were no complications such as intraoperative nail placement resulting in nerve damage, postoperative infection, loosening of internal fixation, or rupture in both groups.

The short-segment reduction and internal fixation of the percutaneous minimally invasive pedicle screw for the treatment of thoracolumbar fractures without decompression has a satisfactory clinical effect. Whether the injured vertebrae is inserted or not has no significant effect on the effect. However, compared with the injured vertebrae without nail placement group, the surgical incision was smaller and the hospitalization cost was lower.