脊柱外固定器联合内窥镜技术治疗胸腰椎爆裂骨折

The clinical application of external fixation assisted endoscopic technique in the treatment of thora-columbar and lumbar burst fracture

目的:探讨脊柱外固定器(percutaneous external transpedicle fixation,PETF)联合内窥镜技术治疗胸腰椎爆裂性骨折的可行性及疗效。方法:2003年9月～2007年1月共收治胸腰椎爆裂性骨折患者43例,单节段骨折35例,双节段骨折8例。均应用新型脊柱外固定器对伤椎进行体外复位固定,并联合应用内窥镜技术实行椎管微创减压,再结合经皮椎体成形术(percutaneous vertabro plasty,PVP)用骨水泥固化伤椎19例,经椎弓根行椎体内植骨24例。随访观察患者伤椎椎体前缘高度比(伤椎椎体前缘高度与上下椎椎体前缘平均高度的比值)、后凸角及椎管狭窄率的变化情况,随访6个月时按照Frankel脊髓损伤分级标准评定患者神经功能恢复情况。结果:所有患者均安全完成手术,无脊髓和神经根的损伤发生,19例行PVP的患者拆除外固定的时间平均为3.74±0.76周,24例骨融合拆除外固定的时间平均在10.4±2.29周,术后随访6～40个月,平均20个月,7例出现外固定器钉孔感染,2例出现螺钉松动,均经相应处理或拆除外固定后治愈,无其他严重并发症发生。伤椎椎体前缘高度比平均恢复至94.5%±6.44%,较术前的58.56%±6.08%明显改善(P<0.01);后凸角由术前的平均29.00°±6.20°恢复至术后的平均4.51°±3.18°(P<0.01);椎管狭窄率由术前的34.20%±8.62%改善至术后的平均7.54%±3.79%(P<0.01);神经功能Frankel分级术后6个月时平均提高1.27±0.58级。结论:脊柱外固定器结合内窥镜下减压技术能实现对胸腰椎爆裂性骨折的体外复位固定和微创减压,既减少了手术创伤又达到了伤椎非椎间融合性固定的目的,是治疗胸腰椎爆裂性骨折的一种有效组合微创手段。

Objective：To study the feasibility and clinical outcomes of a new percutanous external transpedi- cle fixation（PETF） assisted endoscopic techqinque for the surgical treatment of thoralumbar and lumbar burst fracture.Method：From September 2003 to January 2007,43 patients of thoraeolumbar or lumbar burst fracture with spinal stenosis which included 35 one vertebral fractures and 8 double vertebral fractures were analyzed retrospectively.They had been treated by PETF technique combined with vertebral cannal decompression under endoscope and PVP with polymethylmethacrylate（PMMA） or calcium phosphate cement （CPC） or auto bone graft.The changes of anterior height of the vertebral body and kyphotic angle between preoperative and post- operative X-ray examinations were measured.The recovery of nerve function was evaluated by Frankel grade at 6-month follow-up.Result：All patients underwent surgery safely and no severe complications occurred.The av- erage time for removal of PETF was 3.74±0.76 weeks after operation in 19 patients who underwent PVP and 10.40±2.29 weeks in 24 patients who underwent auto bone graft.All patients were followed up for an average of 20 months（range,6-40 months ） .The clinical effect was satisfied except 7 cases who suffered from boh-hole infection and 2 cases appeared screw lossing.The rate of height of anterior border of injury centrum was in- creased obviously from 58.56%±6.08% before operation to 94.50%±6.44% after operation（P〈0.01）.The postop- erative kyphotic angle was 4.51°±3.18° ,and the preoperative kyphotie angle was 29.00°±6.20°（P〈0.01）.The rate of spinal stenosis was decreased significantly from 34.20%±8.62% before operation to 7.54%±3.79% after operation （P〈0.01）.According to Frankel classification,the average recovery of the paralysis raised 1.27±0.58 grade at 6 months follow up.Conclusion：The PETF assisted endoscopic technique and PVP can provide mini- invasion reducation and decompression and non-fusion fixation to the fractured vertebral body,it is an effective combination of mini-trauma methods for the treatment of thoracolumbar and lumbar burst fracture with stenosis.