经椎旁肌间隙入路椎弓根内固定不植骨治疗胸腰椎骨折临床疗效分析

Pedicle fixation without bone fusion for the treatement of thoracolumbar fractures through paraspinal approach

目的:评价经椎旁肌间隙入路椎弓根内固定不植骨治疗胸腰椎骨折的临床疗效。方法:自2006年1月至2009年1月,采用经椎旁肌间隙入路椎弓根内固定不植骨法治疗25例胸腰椎骨折患者,其中男15例,女10例;年龄17～49岁,平均39.3岁。Denis分类:屈曲型7例,爆裂型18例,不伴有神经损伤临床表现,影像学提示椎体矢状面角度变化大于20°和(或)椎体前缘塌陷大于40%,无椎间盘损伤的表现。伤后3～7d行手术治疗,平均5d。术后8～12个月取出内固定,分别于术前、术后1周内及术后24个月行影像学测量比较椎体高度及后凸角度,并将术前及最终随访时Oswestry功能障碍指数(OswestrydisabilityIndex,ODI)进行比较分析。结果:所有患者无手术相关并发症,25例均获随访,其中24例最后随访时间为术后24个月,1例为术后30个月。手术时间70～110min,平均90min;出血量120～280ml,平均200ml。椎体高度及后凸角度明显矫正,术后即刻及最终随访时椎体高度及后凸角度与术前相比差异有统计学意义(P<0.05),内固定取出后最终随访时矫正无明显丢失,与术后即刻相比差异无统计学意义(P>0.05),最终随访时临床结果良好,Oswestry功能障碍指数为(5.36±1.21)%,与术前比较差异有统计学意义(P<0.05)。结论:对不伴有神经及椎间盘损伤Denis分型屈曲型或爆裂型胸腰椎骨折,经椎旁肌间隙入路椎弓根内固定不植骨法具有手术创伤小、术后恢复快及保留脊柱运动节段等优点。

Objective：To evaluate clinical effects of pedicle fixation without bone fusion in treating thoracolumbar fractures through paraspinal approach.Methods：From January 2006 to January 2009,25 patients（15 males and 10 females） with thoracolumbar fractures were treated.The average age was 39.3 years,ranged from 17 to 49 years.According to classification,flexion fracture in 7 cases,brust fracture in 18 cases.There were no nervous injury,and radiology information showed the angle of sagittal vertebral body 20° or collapse of vertebral body 40%,without vertebral injury.The operation were performed at 3 to 7 days after injury（mean 5 day）.Internal fixation implants were removed at 8 to 12 months after operation.The height,kyphosis angle were measured before operation,1 week and 24 months after operation,and Oswestry disability index（ODI） were compared before and after operation.Results：All patients were followed up for 24 months.Among them,1 case was followed up at 30 months after operation.The operation time ranged from 70 to 110（mean 90） minutes,the blood loss was 120 to 280（mean 200） ml.The height of vertebral body and kyphosis angle were obviously corrected,and had significant differences between postoperation immediately and at the final follow up（P〈0.05）.There were no differences after remove of internal fixation（P〈0.05）.The final ODI was（5.36±1.21）%,had statistical differences compared with preoperation（P〈0.05）.Conclusion：For flexion and burst thoracolumbar fractures without nervous injury,pedicle fixation without bone fusion is a good method,which has advantages of minimally invasive,rapid recovery,and maintain spinal motion segment.