经皮椎弓根螺钉固定并伤椎植骨治疗无神经损伤胸腰椎爆裂骨折

Percutaneous Pedicle Screw Fixation Combined with Bone Graft for the Treatment of Thoracolumbar Burst Fractures Without Neurological Deficit

【目的】探讨经皮微创椎弓根螺钉固定加伤椎植骨治疗无神经损伤胸腰椎骨折的可行性及其疗效。【方法]2010年1月至2012年1月，本院收治的85例胸腰椎骨折患者，男57例，女28例；年龄22～55岁，平均48．2岁。其中T1110例，T1220例，L125例，L221例，L39例，均无脊髓神经功能损害。Denis分型为B、C型，栽荷分享评分3～6分，均采用微创经皮椎弓根螺钉固定，伤椎经椎弓根椎体内异体骨植骨方法，记录手术时间，出血量，观察手术前后椎体高度、Cob’S角变化，并统计术后并发症。【结果】所有病例均获随访，平均15（12～18）个月。手术时间平均（120±30）min，术中出血量（200±50）mL。术后椎体高度恢复满意，矢状面畸形矫正，Cobb角矫正至（3．65±2．24）°，与术前比较均有显著性差异（P〈0．01）。随访中无明显的后凸角和高度丢失。3例螺帽脱落，骨折全部获得愈合，无假关节形成。【结论】经皮椎弓根螺钉内固定手术操作简便、安全可靠，具有创伤小、出血少、恢复快、住院时间短等优点。

[Objective] To explore the feasibility and efficacy of percutaneous pedicle screw fixation combined with bone graft for the treatment of thoracolumbar burst fractures without neurological deficit. [Methods]Totally 85 cases of thoracolumbar burst fracture without spine neurological deficit from Jan. 2010 to Jam 2012 were chosen. All patients included 57 males and 28 females. Their age was 22-55 years old, and the average age was 48. 2 years old. There were 10 cases with T11, 25 cases with T 12, 25 cases with L1 , 21 cases with L2 and 9 cases with L3. Accord- ing to Denis classification, all patients were divided into type B and type C. The load sharing score was 3-6. All pa- tients underwent minimally invasive percutaneous pedicle screw fixation combined with bone graft. Operation time and bleeding volume were recorded. Vertebra body height and the change of Cob＇s angle before and after operation were observed. Postoperative complications were analyzed. [Results] All patients were followed up from 12 to 18 months （mean 15 months）. Operation time was （120± 30）min. Bleeding volume was i200±50）ml. Vertebral body height recovered well after operation. The sagittal deformity was corrected, and Cob＇s angle was corrected to 3.65±2.24°. No obvious posterior convex angle and height loss was found during the follow up. The screw shedding was found in 3 patients. All fractures were healed. No formation of false joint happened. [Conclusion] Percutaneous pedicle screw fixation is simple, safe and reliable, and has advantages such as small invasion, less bleeding, rapid recovery and short hospitalization time.