胸腰椎骨折后路微创器械的设计及临床应用

Clinical application of a self-designed minimally invasive device for posterior pedicle screw fixation of thoracolumbar fractures

目的 设计一种胸腰椎骨折后路微创器械,并评估该器械在术中辅助经皮置入椎弓根螺钉治疗胸腰椎骨折的应用价值.方法 设计胸腰椎骨折后路微创器械,并于2004年12月至2006年11月采用该器械术中辅助经皮置入椎弓根螺钉固定治疗17例胸腰椎骨折患者,其中男11例,女6例;年龄27～56岁,平均39.1岁;损伤节段：T112例,T1266例,L136例,L33例.记录并分析手术时间、出血量、伤椎前缘高度比值、后凸Cobb角的恢复情况、复位丢失率,并观察并发症发生情况.结果 本组手术时间平均（110±18）min,出血量平均（120±68）mL.术后所有患者随访14～22个月,平均19个月.伤椎前缘高度比值从术前平均52.1%±2.9%恢复至术后95.2%±0.4%,差异有统计学意义（P〈0.05）;后凸Cobb角从术前15.9°±1.6恢复至术后5.9°±0.9°,差异有统计学意义（P〈0.05）;末次随访复位高度丢失率平均12.1%±0.2%,伤椎前缘高度比值和后凸 Cobb角与术后比较差异无统计学意义（P〉0.05）.随访期间未见感染、腰背酸痛病例,未见术后断钉、断棒等并发症.结论 自行研制的胸腰椎骨折后路微创器械,手术应用效果良好,具有临床推广应用价值.

Objective To evaluate a self-designed minimally invasive device which can facilitate the posterior percutaneous pedicle screw fixation of the thoraeolumbar fractures. Methods From December 2004 to November 2006.17 patients with thoracolumbar fractures were treated by posterior pereutaneous pedicle screw fixation.using a self-designed minimally invasive device to facilitate the operation.We recorded and analyzed the operation time,bleeding volume,anterior border height of the injured vertebra,Cobb angle of kyphosis,late loss of correction,and complications. Results All the patients were followed up for a mean of 19 months（14 to 22 months）.The mean anterior border height of the injured vertebra increased from 52.1%±2.9%preoperatively to 95.2%±0.4% postoperatively,with a significant difference（P〈0.05）.The mean Cobb angle was corrected from 15.9°±1.6°preoperatively to 5.9°±0.9°postoperatively,with a significant difference（P〈0.05）.,The mean late losss of correction was 12.1%±0.2%,the mean operation time was（110±18）min and the mean bleeding volume was（120±68）mL. Conclusion Since the self-designed minimally invasive device can greatly facilitate the posterior percutaneous pedicle screw fixation of the thoracolumbar fractures.it should be recommended for a wider clinical use.