胸椎椎弓根外侧螺钉置入术治疗20例下胸椎骨折

Extrapedicular screw insertion technique for treating lower thoracic spinal fracture in 20 patients

目的研究胸椎椎弓根外侧螺钉置入技术的准确性、安全性和内固定的生物力学稳定性。方法分析应用胸椎椎弓根外侧螺钉置入术治疗20例下胸椎骨折患者临床资料,术后观察有无神经症状或加重,CT扫描观察螺钉周围的皮质骨是否完整,是否靠近前方大血管,是否穿透椎弓根进入椎管,以此评价置入螺钉的准确性和安全性;随访12～24个月(平均16个月)观察骨折愈合情况、椎体高度丢失量、脊柱有无侧弯、内固定螺钉有无失效等指标评价螺钉的生物力学稳定性。结果 20例共置入椎弓根外侧螺钉56枚,术后无神经症状或加重,16例接受CT扫描38枚钉中,2枚破坏椎弓根外壁,2枚破坏椎弓根内外壁,其余34枚椎弓根外侧螺钉周围的皮质骨完整、无螺钉错置,38枚螺钉尖端均未靠近前方大血管,均未超过椎弓根投影的上下缘,置入螺钉的位置准确率为89.4%;全部获得随访,螺钉均未超过椎弓根投影的上下缘,脊柱生理曲度恢复情况良好,骨折全部愈合、伤椎高度无明显丢失、脊柱无侧弯、所有内固定螺钉无失效(松动、拔钉、断裂)。结论胸椎椎弓根外侧螺钉置入技术简单实用、准确性及安全性高,生物力学稳定性好,是胸椎后路内固定的一种良好选择。

Objective To study the accuracy,safety and biological stability of the extrapedicular screw insertion technique in treating lower thoracic spinal fracture.Methods A total of 20 patients with lower thoracic spinal fracture were treated with the extrapedicular screw insertion technique.Patients＇ neurological symptoms were evaluated during the postoperative period.To evaluate the accuracy and safety of the extrapedicular screw insertion technique,CT scanning was performed to observe whether the cortex bone around the screws was complete or whether the screw was close to the front of large blood vessels,or whether the screws entered the the spinal canal through penetrating the vertebral pedicle.All patients were followed up for 12-24 months（mean,16 months）.The biological stability of screws was evaluated through observing the condition of fracture healing,vertebral height loss,scoliosis deformity of thoracolumbar spine,and fixation of internally fixed screws.Results Totally 56 screws were inserted in 20 patients who did not show neurological symptoms or deteriorative neurological symptoms during the postoperative period.Among the inserted 38 thoracic extrapedicular screws in 16 patients who accepted CT scan,2 screws pierced pedical lateral wall,2 screws pierced pedical medial-lateral wall,and the remaining 34 screws achieved satisfactory results.The location of 38 screws was satisfactory,with accuracy of 89.4%.The follow-up showed good screw location,satisfactory recovery in the physiological curvature of the spine,good bone healing,no remarkable loss of injury spinal height,and no failure of screw fixation.Conclusion The extrapedicular screw insertion technique is simple,practical,accurate,safe and biomechanically stable,which is a good alternative to thoracic posterior fixation.