经椎旁肌间隙入路短节段结合伤椎固定治疗胸腰椎骨折

Surgical treatment of thoracolumbar fractures using reduction and short-segment pedicle screw at the fracture level with the approach through para-vertebral muscles

目的:探讨椎旁肌间隙入路短节段固定结合伤椎固定在胸腰椎手术中的优越性和临床应用价值。方法:2007年1月至2010年3月,采用椎旁肌间隙入路短节段固定结合伤椎固定胸腰椎骨折患者27例,男19例,女8例;年龄21～57岁,平均36.3岁。按照Magerl等分型:A2型5例,A3型14例,B1型3例,B2型5例。按Frankel神经功能分级:D级6例,E级21例。比较术前、术后及末次随访时X线片及CT,对伤椎椎体压缩百分率、Cobb角、椎管占位等情况进行随访;通过Frankel标准对神经功能进行评定。结果:所有病例获得随访,时间12～28个月,平均19.6个月。椎体压缩百分率由术前的(46.6±10.5)%恢复至术后的(5.2±3.7)%,末次随访时的(6.7±4.6)%,术后与术前比较差异有统计学意义(P<0.05),末次随访时与术后比较差异无统计学意义(P>0.05);伤椎Cobb角由术前的(18.3±7.2)°矫正至术后(5.3±5.1)°,末次随访时的(7.1±3.1)°,术后与术前比较差异有统计学意义(P<0.05),末次随访时与术后比较差异无统计学意义(P>0.05);椎管占位率由术前的(30.2±7.2)%恢复至术后的(6.3±4.2)%,末次随访时的(7.2±4.5)%,术后与术前比较差异有统计学意义(P<0.05),末次随访与术后比较差异无统计学意义(P>0.05)。其中3例神经功能D级患者恢复至E级。结论:经椎旁肌间隙入路短节段结合伤椎固定治疗胸腰椎骨折具有操作简单,置钉容易,手术时间短,出血少,同时复位良好,术后稳定可靠,是治疗胸腰椎骨折的有效方法。

Objective：To evaluate the efficacy and clinical outcome of reduction and pedicle screws fixation at the fracture level with the approach through para-vertebral muscles in treating thoraeolumbar fractures. Methods：From January 2007 to March 2010,27 patients with thoracolumbar fractures were treated with posterior open reduction and internal fixation with the approach through para-vertebral muscles. There were 19 males and 8 females with the mean age of 36.3 years old （ranged,21 to 57）. According to Magerl type,type A2 was in 5 cases,A3 in 14,B1 in 3,B2 in 5. According to Frankel classification of spinal cord injury： grade D was in 6 cases and grade E in 21 cases. X-rays and CT scans were performed after operation. Cobb angle of the injured vertebral segment,the percentage of vertebral compression,and sagittal diameter stenosis rate of the injured spinal canal were observed by radiographic data. Neurological function was evaluated by the Frankel grade. Results：All patients were followed up from 12 to 28 months with an average of 19.6 months. The percentage of vertebral compression,Cobb angle of the injured vertebral segment,spinal canal sagittal diameter stenosis rate were respectively corrected from （46.6±10.5）%,（18.3±7.2）°,（30.2±7.2）% to postoperative（5.2±3.7）%,（5.3±5.1） °,（6.3±4.2）% and（6.7±4.6）%,（7.1±3.1） °,（7.2±4.5）% at last follow-up. There were significant difference in above items between preoperation and postoperation（P0.05）; and there was no significant difference in above items between postoperation and last follow-up（P0.05）. In aspect of nerve function,3 cases with Frankel grade D recovered to grade E. Conclusion：Using reduction and short-segment pedicle screws fixation at the fracture level through para-vertebral muscles approach is an effective method in treating thoracolumbar fractures. The method has advantages of simple operation,easy establishing screw,short operative time,less blood loss,which can obtain good reduction and stable,reliable fixation after operation.