经皮单节段椎弓根螺钉固定治疗胸腰段骨折的临床研究

Clinical research of percutaneous monosegmental pedicle screw instrumentation for traumatic thoracolumbar fractures

目的探讨经皮单节段伤椎置钉选择性治疗胸腰段骨折的适应证及疗效。方法经皮后路伤椎置钉单节段内固定治疗胸腰段骨折19例。AO分型:A1.1型2例,A1.2型14例,A3.1型3例。观察手术前后视觉模拟量表(visual analog scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)、椎体的高度、伤椎后凸、内固定物并发症。结果平均随访时间16.3个月,手术时间平均67 min,术中平均出血量95 mL。术后VAS评分、ODI较术前获得明显改善(P<0.05)。伤椎矫正复位率为(91.44±3.71)%,远期丢失率(7.78±2.80)%。所有病例均获得骨性融合,无内置物相关并发症。术后无脊髓损伤、感染等并发症发生。结论合理选择适应证,经皮单节段椎弓根螺钉固定术治疗胸腰段骨折具有创伤小、用时短、出血少、脊椎运动功能单位丢失减少等优点,是治疗部分创伤性胸腰段骨折的有效方法。

Objective To evaluate the clinical efficacy of percutaneous monosegmental pedicle screw instrumentation （MPSI） in management of traumatic thoracolumbar fractures. Methods Nineteen patients with traumatic thoracolumbar frac- tures were treated by MPSI. According to AO classification, 2 cases were type A1. 1, 14 were type A1.2 and 3 were type A3. 1. Radiologic outcomes including wedge index and Cobb＇ s angle and clinical ones including visual analog scale （VAS） scores and Oswestry disability index （ODI） were analyzed. Results All of the operations were performed safely. The average operative time was 67 min ,with average estimate blood loss of 95 mL. Nineteen patients were followed up successfully for aver- age 16.3 months. All the patients achieved bone fusion without implant failure or screw dislodgement. The vertebral height per- cent and Cobb＇ s angle were improved significantly （P 〈 0.05）. The VAS scores and ODI of all the patients during follow-up improved significantly （ P 〈 0.05 ）. Conclusion MPSI is an effective and reliable operative technique for selected traumatic thoracolumbar fractures with advantages of minimal invasion, shorter operative duration, less blood loss and decreased vertebral motion segment loss.