应用Moss Miami椎弓根钉系统治疗胸腰椎爆裂骨折改善脊柱活动度及神经功能的评估(英文)

Evaluation of spinal movement and neurological function in the treatment of thoracolumbar burst fractures by Moss Miami pedicle screw instrumentation

背景:胸腰椎爆裂骨折的治疗,尤其是关于实施前、后路手术及减压范围,内固定装置的选择仍存在较大的争议。目的:探讨MossMiami系统治疗胸腰椎爆裂骨折,改善患者脊髓功能、脊柱活动度及下肢疼痛的效果。设计:前后对照分析。对象:选择广州市第一人民医院骨科脊柱外科2001-01/2003-06收治的胸腰椎爆裂骨折行MossMiami椎弓根钉系统固定患者27例。患者均签署知情同意书。男17例,女10例;年龄19～65岁,平均32.8岁。损伤部位:L114例,T126例,T12,L14例,L1,L22例,L1,L2,L31例;其中有脊髓损伤11例,Frankel分级为A级1例,B级2例,C级8例。术前CT显示椎管狭窄率(43±13.5)%。干预:19例进行MossMiami椎弓根钉内固定加椎板间植骨融合术,8例经后外侧减压、半椎板切除,MossMiami椎弓根钉内固定加后外侧横突间植骨融合术。脊髓功能恢复按Frankel分级评定(分为5级,A级为严重障碍,E级为正常);术后疗效评价根据神经功能、脊柱活动、腰背痛及下肢疼痛恢复情况评估(分为改善、无变化、加重)。主要观察指标:①患者应用MossMiami椎弓根钉内固定术后疗效评价。②手术前后和随访时患者伤椎椎体前后高度及椎管狭窄率。③手术前后患者脊髓功能恢复情况。结果:随访时间6个月,27例患者均进入结果分析。①MossMiami椎弓根钉内固定术后疗效评价结果:神经功能改善10例,无变化1例;脊柱活动改善26例,无变化1例;下肢疼痛改善10例,无变化17例;腰背痛改善23例,无变化3例,加重1例。②手术前后和随访时患者伤椎椎体前后高度及椎管狭窄率结果:随访时伤椎前后高度及椎管狭窄率均较手术前有显著改善[伤椎前高度:93.5%比44.2%;伤椎后高度:90.7%比79.3%;椎管狭窄率:(8.2±6.6)%比(43.0±13.5)%,P<0.01]。手术后和随访时比较无明显差异(P>0.05)。③术后脊髓功能Frankel分级评定结果:11例脊髓损伤患者中,10例分别提高1～3级,1例A级无变化。结论:MossMiami系统治疗胸腰椎爆裂骨折,能明显改善患者脊髓功能,恢复椎体高度,操作简单,复位固定效果满意。

BACKGROUND： The treatment of thoraeolumbar burst fractures, especially the anterior or posterior approaches for decompression, the extent of deeompressinn, and the selection of the internal fixation deviees have long been controversial. OBJECTIVE： To investigate the effect of Moss Miami pediele screw instrnmentation on spinal funetian, spinal moventent and the improvement of pain relief in the lower limbs in patients with thoraeolumber burst fractures. DESIGN： A self-controlled analysis. PARTICIPANTS： Totally 27 patients who suffered from tboraeolumbar burst fractures treated at the Department of Orthopaedie Spine Surgery of Guangzhou First People＇s Hospital from January 2001 to June 2003 with Moss Miami pedicle screw instrumentation were involved.lnformed eonsents were obtained from the patients.There were 17 male patients and 10 female potients with ages varying from 19 to 65 years （32.8 years in average）.Jnjury loei：14 cases were injured at 11 6 at T12 4 at T12-l1, 2 at l1-3 l atL1-3 11 cases had a spinal injury.Aeeontingto Frankel evaluation system, l case helonged to Frankel A; 2 cases belonged to Frankel B; 8 eases belonged to Frankel C. The stenosis rate of vertebral canal before the operation showed by CT was（43±13.5）%. INTERVENTIONS： Totally 19 eases received posterior Moss Miami pediele screw internal fixation eombined with interlamina bone grafting fusion, and 8 eases underwent posterolateral decompression and hemilamineetomy, combined with posterolateml fusion and posterior Moss Miami pediele screw internal fixation. Spinal function recovery was evaluated according to Frankel grading scale （5 degrees, grade A means very severe and grade E means normal）; Post-operation curative effect evaluation was made according to neurological function, spinal movement, pain on the lumbar and back as well as the recovery condition of the pain on the lower limbs （improved, no ehange, worsening）. MAIN OUTCOME MEASURES： ①Curative effect evaluation with Moss Miami pedicle screw instrumentation,②Anterior and posterior height of injured vertebra of preoperation, postoperation and at the follow-up. And the spinal canal stenosis was observed in evaluation. ③Preoperative and postoperative recovery of the spinal function. RESULTS： Twenty-seven patients entered the stage of result analysis after a 6-month follow-up. ①Curative effect evaluation after Moss Miami pediele screw internal fixation： Neural function improved in 10 patients, no change was observed in 1 patient; Spinal movement improved in 26 cases, and no change was noted in 1 ease; pain in the lower limbs was improved in 10 cases and no change was noted in 17 cases; pain in the lumbar and back was improved in 23 cases and no change was observed in 3 cases and it was worsening in 1 case. ②Anterior and posterior height of injured vertebra as well as spinal canal stenosis preoperatively, postoperatively and in the follow-up： Anterior and posterior height of injured vertebra as weil as spinal canal stenosis was significantly improved compared with that before operation [Anterior height of injured vertebra： 93,5% vs 44.2%;Posterior height o（ injured vertebra： 90.7% vs 79.3% ;spinal canal stenosls rate： （8.2 ± 6.6）% vs （43.0 ± 13.5）% ,P 〈 0.01]. There was no significant difference between postoperation and the follow-up （P 〉 0.05）. ③Frankel grading of spinal function postoperatively： Among the 11 patients with spinal injury, neural function recovery was enhanced 1-3 levels in 10 patients, but no change was ob^rved in 1 patient （Grade A）, CONCLUSION： The application of Moss Miami pedicle screw instrumentation in the treatment of burst fractures can markedly improve the ftmctions of the spinal cord, and recover the height of vertebrae. The manipulation of the proeedure is simple, and the effect of reduction fixation is satisfactory.