经皮附加伤椎椎弓根螺钉内固定治疗胸腰椎骨折

Application of mini-invasive percutaneous pedicle screw fixation in thoracolumbar fracture

背景:随着新型内固定器械的出现及影像学技术的发展,微创脊柱外科技术已经越来越广泛的应用于脊柱创伤的治疗。目的:探讨经皮附加伤椎椎弓根螺钉内固定术治疗无神经损伤的胸腰椎骨折的可行性及疗效。方法:选择2009年6月至2011年6月在我科住院治疗的28例无神经功能损害的胸腰椎骨折患者,采用附加伤椎椎弓根螺钉固定技术,分别给予Sextant或Viper经皮椎弓根螺钉内固定(微创组)[共12例,男8例,女4例,年龄(38.5±7.2)岁]和传统切开内固定组(开放组)[共16例,男12例,女4例,年龄(41.3±9.1)岁],比较围手术期参数、影像学指标、视觉模拟评分法(VAS)及疗效情况(改良MacNab疗效评定标准)。结果:所有患者均获得随访,随访时间为6～15个月,平均(12.5±5.4)个月。微创组较开放组不仅住院时间明显缩短,术中出血、术后伤口引流量显著减少,而且肌酸激酶升高程度明显减低,术后腰背部疼痛明显减轻,术后功能恢复明显(P<0.05)。所有患者术后Cobb角和伤椎椎体前缘高度较术前均有显著恢复(P<0.05),但两组手术前后比较无差异(P>0.05)。两组椎弓根钉置入准确率比较无差异(P>0.05)。结论:经皮附加伤椎椎弓根螺钉内固定技术具有创伤小、出血少、恢复快等优点,对伤椎畸形矫正程度与传统开放手术相当,是治疗无神经损伤的胸腰椎骨折的较好选择。

Background： The enhancement of the new implant materials and improved intraoperative imaging has led to the development of novel minimally invasive surgical techniques for the treatment of spinal trauma. Objective： The aim of the study is to explore the feasibility and effect of the mini-invasive pereutaneous pediele screw fixation for the patients with thoraeolumbar fracture using multi-level Sextant or Viper system. Methods： From June 2009 to June 2011, 28 thoracolumbar fracture patients without neural impairment were selected. They were divided into 2 groups： 12 cases （8 males and 4 females, age 38. 5 ±7. 2） were included in the multi-level Sextant or Viper percutaneous pedicle screw fixation group and 16 cases （ 12 males and 4 females, age 41.3±9. 1 ） were in the open pedicle screw fixation group. Perioperative parameter, pre and post operative imaging index, visual analog scale （VAS） and modified Macnab evaluation standard were compared. Results： All cases were followed up from 6 to 15 months （mean 12. 5±5.4 months）. There were significant differences in the surgical blood loss, surgical draining loss, hospital stay postoperative, VAS score and clinical response between the two groups （P 〈 0.05 ）. The Cobb＇s angle and anterior height of the fracture vertebral body were all significantly different between preoperation and post-operation in each group （ P 〈 0. 05 ）. There was no significant difference in incision size, surgical time, postoperative improvement of Cobb angle, anterior height of the fracture vertebral body and accuracy of pedicle screw placement in the two groups. Conclusions： The mini-invasive percutaneous pedicle screw fixation tor fractured vertebra using multi-level Viper system is a goodtherapeutic choice for patients with thoracolumbar fracture. This method is with less blood loss and trauma and can provide quicker recovery and shorter stay in hospital and comparable result of the traditional open operation.