内镜辅助下经皮椎弓根螺钉固定术治疗胸腰椎骨折

Endoscopy assisted percutaneous screw fixation for the treatment of thoracolumbar fracture

目的试图在显微内镜下椎间盘切除系统(MED系统)的辅助下,探索一种新的经皮椎弓根螺钉固定方法治疗胸腰椎骨折。方法共给13例L1和T12爆裂型骨折进行了治疗。先在内镜下置入椎弓根螺钉,然后改用自制的半管状微型拉钩暴露螺钉钉头,分离椎旁肌后装上连接杆复位,并在镜下进行减压和椎体内植骨。结果平均手术时间110min,平均出血量120mL。术后无须注射镇痛治疗。后突角度平均由术前的32°降为术后3°。高度丢失由术前的47%失变为术后的15%。术后腰背痛消失,未出现并发症。随访期间内固定可靠,无松动。平均骨折愈合时间为5个月。结论该手术有如下优点:技术安全、简单;骨折复位满意,内固定可靠;术中血量少,术后疼痛轻微;且无须从髂骨取骨。

[Objectives] To design a new technique for thoracolumbar fracture, in which percutaneous pedicle screw fixation aided with MED system was applied. [Methods] Surgeries had been operated on 13 patients with burst fracture in L1 or T12. Pedicle screw was placed microendoscopically, and then the head of the pedicle screw was exposed with self-designed semi-tubular micro-retractors. The connecting rod was placed to reduce fracture after paraspinous muscle splited bluntly. Decompression and intrabody graft were completed cndoscopically. [Results] The operating time averaged 110 minutes while the mean blood loss was 120 ml. None of them needed injective analgesic postoperatively. Kyphesis decreased from 32 preoperatively, to 3 degrees postoperatively, while the loss of vertebral body height from 47% to 15%. Back pain disappeared in all patients and no complication was notified. The fixation system had not loosened through out the follow-up range. Bone healing occurred in an average of 5 months. [Conclusions] The technique has the advantages of safe and simplified manipulation, satisfied reduction, secure fixation, less blood loss and mild postoperative pain, no need for bone graft from iliac crest.