经皮椎弓根内固定术在胸腰椎骨折中的应用

Application of percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures

[目的]应用经皮椎弓根内固定技术治疗胸腰椎骨折。[方法]本组病例全部使用丹历·枢法模公司生产的CotrelDuboussetHorizon(CDH)椎弓根内固定系统。在骨折节段上、下相邻椎弓根皮肤处作4个1.5cm长纵形切口,电视透视监视下,钻入椎弓根螺钉,从一端切口纵形将固定棒置入肌纤维间隙内,棒的两端置入上、下2枚椎弓根钉的槽口内,拧入固定螺钉,初步固定,撑开复位并矫正屈曲畸形。[结果]手术出血量平均85ml。住院时间平均10d。平均骨折愈合时间术后10周。术中未发生椎弓根钉误入椎管、脊神经或马尾神经损伤并发症。[结论]经皮椎弓根内固定技术可使不稳定胸腰椎骨折获得坚强固定,手术操作简单安全,创伤轻、痛苦小,患者康复快。

[Objective] To investigate the effect of percutaneous transpedicular screw fixation in the treatment of thoracolumbar vertebrae fractures. [ Method] Twenty-six patients of single segment and unstable thoracolumbar vertebrae fractures were treated with this technique. The patients included 5 cases of T12 fractures, 16 L1 , 4 L2 and 1 L3, with 21 male and 5 female patients whose mean age was 37 years old （from 21 to 48 years）. All 26 patients with no neurological deficits had normal or slightly narrowed spinal canal （ Worter sagittal index 1° which means the decrease of cross-sectional area of spinal canal was less than one fourth）. All patients were treated with CDH transpedicular screw internal fixation system manufactured by DANEOU SOFAMOR Company. Under fluoroscopy, 4 incisions of 1.5 cm were made at the position of vertebrae pedicles above and under the fracture segment. After the transpedicular screws had been placed into the pedicles of vertebrae, the fix rod was placed percutaneously through the muscle tunnel and connected to the upper and lower screw. The kyphotic deformity was corrected after that.[Result] All 26 patients were followed up at an average time of 18 months （from 8 to 24 months）. Mean operative time was 45 minutes and blood loss was 85ml. Mean time in hospital was 10 days. Patients could sit up mean 3 days after operation under the protection of waist backboard splint and could be off bed 10 days postoperatively. Fractures knitted at 10 weeks postoperatively and the mean hack-to-work time was 12 weeks after operation. No transpedicular screws misplaced in spinal canal, no neurological deficits happened. [ Conclusion] Percutaneous transpedicular screw internal fixation technique could fix the unstable thoracolumbar fractures rigidly. The operation procedure is easy, mini-invasive. Patients recovered sooner with fewer suffering.