经皮椎弓根内固定治疗胸腰椎骨折的效果及并发症分析

Therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures

目的 探讨经皮椎弓根内固定治疗胸腰椎骨折的效果及并发症.方法 2002年1月至2008年12月,采用经皮椎弓根内固定术治疗胸腰椎患者103例,其中男性75例,女性28例;年龄18～72岁,平均45.6岁;所有患者均无神经损害表现.致伤原因：交通事故65例,高空坠落23例,重物砸压15例.Denis分型：压缩型64例,爆裂型39例.骨折椎体：T115例,T1230例,L1 42例,L215例,L3 4例,L4 3例,T11-122例,L1～21例,L2～31例.通过总结影像学和临床随访结果对经皮椎弓根内固定术的临床效果及其并发症进行评价分析.结果 失访21例,其余82例患者随访时间10～48个月,平均27.4个月.椎体前缘高度、后凸Cobb角、椎管堵塞指数分别由术前的（54.5±8.7）%、16.4°±2.9°和1.2±1.0改善至术后的（88.6±6.4）%、11.6°±2.7°和0.5±0.6.视觉模拟评分、Oswestry功能障碍指数评分分别由术前8.0±1.2及41.2±9.3改善至术后1.7±1.8及6.7±5.6.各组数值手术前后差异均有统计学意义（P＜0.01）.并发症包括椎弓根螺钉位置不正确7例;创面浅表感染者1例;椎弓根螺钉断裂3例;椎弓根螺钉退出2例;强化剂渗漏5例;暂时性神经症状4例;8例患者诉仍感腰背部疼痛,其中2例患者需不定期口服止痛药.82例患者均获骨性愈合.结论 经皮椎弓根螺钉内固定术具有操作简便、创伤小、术后恢复快等优点,临床疗效与开放性手术相近,可作为无神经症状胸腰椎骨折治疗的手术方式之一.

Objective To investigate the therapeutic effects and complications of percutaneous pedicle screw fixation for thoracolumbar fractures. Methods From January 2002 to December 2008,103 patients with thoracolumbar fractures were treated with percutaneous pedicle screw fixation, including 75 males and 28 females, the average age was 45.6 years （ range, 18-72 years）. All of them were of no neurological deficits. There were 65 cases of traffic injury, 23 cases of fall injury and 15 cases of smashed injury. According to the Denis classification, 64 patients were of compression fractures, and 39 patients of burst fractures. There were 5 cases had fractures in T11, 30 in T12, 42 in L1, 15 in L2, 4 in L3, 3 in L4 ,2 in T11-12, 1 in L1-2, and 1 in L2-3. Radiological examinations, including X-ray and CT examinations, and clinical examinations were carried out to evaluate the therapeutic effects. Results Twenty one patients were lost to follow up, the remaining were followed up from 10 to 48 months with an average of 27.4 months.Before the operation, the vertebral height, the kyphposis angle and the occupation of spinal canal were （54. 5 ±8. 7）%, 16. 4°±2. 9°and 1.2 ± 1. 0, and were improved to （88.6 ±6. 4）%, 11.6°± 2. 7°and 0. 5 ± 0. 6 respectively after the operation. Preoperatively the visual analogue scale and the Oswestry disability index were 8. 0 ± 1.2 and 41.2 ± 9. 3, and were improved to 1.7 ± 1.8 and 6. 7 ± 5.6 postoperatively,respectively. All of these values between pre- and post-operatively were significantly different （P ＜0. 01 ）. Screw misplacement was found in 7 patients, superficial wound infection in 1, screw breakage in 3, screw dislodgment in 2, cement leakage in 5, transient neurological symptoms in 4, and 8 patients with low back pain remained,of which 2 patients required occasional oral analgesics. Bone fusion achieved in all cases. Conclusions The clinical efficacy of percutaneous pedicle screw fixation is similar with conventional open surgery. With the advantages of convenient procedure, less invasive, and rapid recovery, percutaneous pedicle screw fixation is an altermative method for thoracolumbar fiactures without neurological deficits.