摘要
背景：经伤椎椎弓根钉内固定术治疗单节段胸腰椎爆裂性骨折可增加脊柱的生物力学稳定性,明显降低术后内固定失败、伤椎椎体高度矫正丢失等并发症的发生率,但传统开放手术需广泛剥离椎旁肌止点,创伤大、出血多、恢复慢。目的：评估经伤椎微创椎弓根钉内固定术（微小切口非空心椎弓根钉技术）治疗胸腰椎爆裂性骨折的疗效。方法：2011年4月至2011年9月行经伤椎微创椎弓根钉内固定术治疗20例单节段胸腰椎新鲜爆裂性骨折且无神经症状的患者,男12例,女8例;年龄41~60岁,平均（50.3±5.5）岁,伤椎位于T11~L2,均属A3型骨折。记录手术时间、术中出血量和住院天数,观察并记录术前、术后即刻、术后1个月、术后2个月、术后个3月、术后6个月、术后1年、术后2年的腰背痛VAS评分,比较术前及术后各时间点的VAS评分、椎体高度压缩率、后凸角及术后各时间点的椎体高度恢复率、后凸矫正率。结果：手术时间为80~110 min,平均（90±9）min;出血量为40~95 ml,平均（68±17）ml;住院时间5~8 d,平均（6.7±1.2）d。20例全部获得随访,随访时间为24~29个月,平均（26±2）个月。VAS评分由术前（8.5±1.1）分明显下降至术后即刻（1.9±0.6）分（P〈0.001）及2年随访时（0.4±0.5）分（P〈0.001）;椎体高度压缩率由术前（49.3±7.4）%显著下降至术后即刻（5.2±1.6）%（P〈0.001）及2年随访时（7.0±1.5）%（P〈0.001）;后凸角由术前22.0°±1.9°下降至术后即刻3.1°±1.8°（P〈0.001）及2年随访时6.1°±1.4°（P〈0.001）。术后随访过程中椎体高度恢复率、后凸矫正率无明显减小。无一例出现螺钉松动、断钉及断棒。结论：经伤椎微创椎弓根钉内固定术是治疗胸腰椎爆裂性骨折安全而有效的方法,并应严格掌握其手术适应证。
Background： Traditional short nonsegmental posterior fixation for thoracolumbar burst fractures often suffers from high rates of failure. Constructive stability may be improved by inserting additional screws at the injured level. But there are more intraoperative blood loss, more postoperative pain and longer hospital stay during open surgery. Objective： To evaluate the feasibility and safety of minimally invasive short-segment posterior fixation at the level of the fracture for treating acute thoracolumbar burst fracture. Methods： Twenty patients who sustained thoracic or lumbar fresh A3 burst fracture without neurologic deficits underwent minimally invasive pedicle screw fixation at the level of fracture and adjacent vertebrae. There were 12 males and 8 females with an average age of （50.3 ±5.5） years （ranging 41-60 years）. The injured vertebrae ranged from T11 to L2. Operation time, intraoperative blood loss and hospital stay were recorded. Visual analog scale （VAS） scores, Cobb angles and anterior vertebral body height were measured before surgery and immediately, 1, 2, 3, 6, 12 and 24 months after surgery. Results： The average operation time was （90±9） min （ranging 80-110 min）. Blood loss was （68± 17） ml during the procedure （ranging 40-95 ml）. The average hospital stay was （6.7± 1.2） d （ranging 5-8 d）. The duration of follow-up was （26±2） months on average in all the patients （ranging 24-29 months）. Compared with the preoperative ones, the VAS scores were significantly decreased immediately and 2 years after surgery （8.5± 1.1, 1.9±0.6, 0.4±0.5, P〈0.001）, the Cobb angles were significantly decreased immediately and 2 years after surgery （22.0°±1.9°, 3.1 °±1.8°, 6.1 °±1.4°, P〈 0.001）, and the com- pression rate of vertebral body height were also significantly decreased immediately and 2 years after surgery （49.3%~7.4%, 5.2%＋1.6%, 7.0%~1.5%, P〈0.001）. No significant changes in both kyphosis correction and vertebral body height restora- tion were observed during follow-up. There was no patient with the failure of instruments during the follow-up.Conclusions： Minimally invasive short-segment posterior fixation at the level of fracture is a good choice for the treatment of acute thoracolumbar burst fracture.
出处
《中国骨与关节外科》
2014年第5期408-411,407,共5页
Chinese Journal of Bone and Joint Surgery
关键词
胸腰椎爆裂性骨折
经伤椎椎弓根钉内固定
微创脊柱外科
后凸矫正率
椎体高度恢复率
thoracolumbar burst fracture
segmental posterior fixation
minimally invasive spinal surgery
kyphosis correc-tion
vertebral height restoration
