经皮椎弓根技术治疗胸腰椎骨折的临床探讨

Minimally invasive percutaneous pedicle screws osteosynthesis for the treatment of thoracolumbar fracture

目的：探讨微创经皮椎弓根螺钉内固定手术治疗胸腰椎骨折的可行性及其疗效.方法：20例胸腰椎骨折病例,男13例,女7例;年龄28～65岁,平均48.2岁.其中16例损伤平面以下无神经功能损害、无双下肢和大小便障碍;4例有不同程度的脊髓损伤,按Frankel分级：C级1例,D级3例.在C形臂X线的定位下确定需要固定的椎弓根根部,做4个1.5 cm长的切口,固定与复位均在4个小切口内完成.结果：所有病例均获随访,时间9～18个月,平均15个月.术后患者椎体高度均有不同程度恢复,椎体后凸畸形获得不同程度矫正.手术时间约1.5 h,出血量约80 ml.结论：微创经皮椎弓根螺钉内固定手术操作简便、安全可靠,具有创伤小、出血少、疼痛轻、恢复快、住院时间短等优点.

Objective：To investigate the feasibility and effect of minimally invasive percutaneous pedicle screws osteosynthesis （MIPPSO） for thoracolumbar fracture. Methods：Twenty patients of thoracolumbar franture（ 13 male and 7 female） ,with mean age 48.2 years（ range from 28 to 65 ）. Spinal injury was found in 4 cases, which Frankel C in one case and Frank D in 3 cases. Under the c-arm intensifier,pedicle root were exposed,fractures were reduced and fixed through four small incisions（ length was 1.5 cm）. Results：All patients were followed up with an average of 15 months （range 9 - 18 months）. The vertebral body height and the kyphosis deformities obtained different recovery and correction in all cases. The operation time was 1.5 hours,and the blood loss was 80 ml on average（ range from 30 to 280 ml）. Conclusion：MIPPSO is safe for thoracolumbar fracture which has the advantages of simple manipulation, minimal trauma, less bleeding, light pain, quick recovery and short hospitalization time.