附加伤椎固定的微创经皮椎弓根螺钉（Sextant）治疗胸腰椎骨折

Additional fixation of injured vertebra with percutaneous pedicle screws（Sextant system） for thoracolumbar fractures without neural symptoms

目的比较附加伤椎固定的微创经皮椎弓根螺钉（Sextant）与传统跨伤椎微创经皮椎弓根螺钉内固定治疗胸腰椎骨折的疗效。方法自2007年9月至2009年3月，对35例胸腰椎骨折患者采用微创经皮Sextant固定系统进行回顾性分析，根据固定方式分为跨伤椎微创经皮内固定组（4钉组，21例）和附加伤椎内固定组（6钉组，14例），分析两组围手术期相关指标以及后凸畸形矫正情况。结果所有患者获得9～24个月（平均12．0个月）随访。4钉组与6钉组在手术时间、术中出血量、术后住院时间、术后使用镇痛药比例及术后伤口疼痛评分方面差异均无统计学意义（P〉0．05）；两组术后Cobb角、矢状位指数、伤椎前缘和后缘高度的恢复均较术前有改善，差异均有统计学意义（P〈0．05）；两组手术前后伤椎前缘及后缘高度改善度比较差异均有统计学意义（P〈0．05）；术后伤椎前缘高度改善度与后缘高度改善度两组比较差异均有统计学意义（P〈0．05）；其余各影像学指标间差异均无统计学意义（P〉0．05）。4钉组出现断钉1例，无螺钉松动；6钉组未出现螺钉松动及断钉现象。结论微创经皮Sextant内固定技术操作简便、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，附加伤椎微创经皮内固定较跨伤椎的微创经皮内固定在矫正伤椎前缘、后缘高度方面有较大优势。

Objective To compare the therapeutic results of additional fixation of the injured vertebra and conventional fixation across the injured vertebra with percutaneous pedicle screws （Sextant system） for the thoraeolumbar fractures without neural symptoms. Method From September 2007 to March 2009, 35 patients with thoracolumbar fracture were treated with the Sextant-R percutaneous pedicle screw fixation system. Of them, 21 were treated with four pediele screw fixation （FPSF） and 14 with six pedicle screw fixation （SPSF）. The perioperative indexes and corrections were compared between the 2 groups. Results There were no significantly differences （ P 〉 0. 05） in surgical time, surgical blood loss, postoperative hospital stay, postoperative administration of analgesics and postoperative pain evaluation in the two groups. In each group, there were significant differences between preoperation and postoperation （ P 〈 0. 05） in the Cobb angle, sagittal index, anterior and posterior heights of the injured vertebral body. Compared with the FPSF group, the SPSF group had significantly better improvement （ P 〈 0.05） in the anterior and posterior heights of injured vertebral body. Conclusions The minimally invasive percutaneous pedicle screws （Sextant system） have the advantages of simple manipulation, safety, limited trauma, less bleeding, less pain, quick recovery and short hospitalization time. Compared with the FPSF, the SPSF may be superior in resuming the anterior and posterior heights of the fractured vertebral body.