微创经皮椎弓根内固定术治疗胸腰椎骨折

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

目的探讨应用微创经皮椎弓根内固定术治疗胸腰椎骨折的疗效。方法2000年3月～2004年5月，采用经皮椎弓根内固定术治疗单节段、不稳定胸腰椎骨折32例。其中T128例，L116例，L26例，L32例。患者全部使用丹历．枢法模公司生产的CDH椎弓根内固定系统。在骨折节段上、下相邻椎弓根皮肤处做4个1．5cm长的纵形切口，透视下，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，初步固定钉棒，撑开复位并矫正屈曲畸形。并以同期32例采用传统后路切开复位椎弓根内固定技术治疗的类似患者作为对照，比较两组的疗效。结果经皮组32例患者术后获24～52个月（平均36个月）随访。手术时间平均为42．06min，手术出血量平均为83．69mL，住院时间平均为11．75d，术后恢复工作时间平均为12周，术后2年后凸Cobb角轻度丢失。与对照组比较，经皮组手术时间、住院时间明显缩短，出血量明显减少，术后恢复快。结论经皮椎弓根内固定术治疗胸腰椎骨折，复位及内固定效果好，手术操作简单安全、创伤轻、痛苦小，患者康复快。

Objective To explore the percutaneous transpedicular screw fixation in the treatment of thoracolumbar vertebral fractures. Methods From March 2000 to May 2004, 32 （23 males and 9 females） patients with single segmental and unstable fractures of thoracolumbar vertebrae were treated with percutaneous transpedicular screw fixation. There were 8 cases of T12 fractures, 16 cases of 6 L1, 6 cases of L2 and 2 cases of L3. All the 32 patients had no neurological deficits, and normal or slightly narrowed spinal canals （less than Woher sagittal index 1 ）. 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 vertebral pedicles above and below the fracture segment. After the transpedicular screws were placed in the pedicles, the fixation rod was inserted percutaneously through the muscle tunnel and connected to the upper and lower screws. After retraction reduction, the kyphotic deformity was corrected. Another contemporary 32 cases who were treated with traditional posterior open reduction and internal screw fixation were used as contrast. Results All the 32 patients in the percutaneous group were followed up for an average time of 36 months （range, 24 to 52 months）. Their mean operative time was 42.06 minutes, blood loss was 83. 69 mL, hospital stay was 11.75 days, and back-to-work time was 12 weeks after operation. The percutaneous group was superior to the contrast group in operation time, hospital stay, blood loss and postoperative recovery. Conclusions Percutaneous transpedicular screw internal fixation can fix the unstable thoracolumbar fractures rigidly. The operation procedure is easy and minimally invasive. The patients can recover soon with mild sufferings.