U形可折断椎弓根螺钉微创内固定治疗胸腰椎骨折

Minimal invasive internal fixation with U-shaped break-off pedicle screws for treatent of thoracolumbar fractures

目的：探讨应用U形可折断椎弓根螺钉利用椎旁肌间隙通过小切口微创内固定治疗胸腰椎骨折的疗效及其优越性.方法：选择2010年8月至2012年6月,共40例胸腰椎骨折患者,男27例,女13例,年龄22~60岁.T11骨折4例,T12骨折13例,L1骨折17例,L2骨折6例.依据Denis骨折分型,均为爆裂型骨折,椎管占位小于1/3.依据AO分型,均为A型或B1型损伤.均无神经损伤症状和体征.患者随机分为2组,A组（微创组）20例采用U形可折断椎弓根钉小切口微创内固定手术方法于伤椎上下一个节段植入椎弓根钉;B组（开放手术组）20例采用常规后正中入路开放椎弓根钉固定手术,比较两组手术时间、术中出血量、术后引流量、手术前后VAS评分、X线暴露时间、远期随访结果.结果：微创组在手术时间、术中术后出血量、术后早期缓解疼痛等方面较开放手术组有显著优势,在X线暴露时间和远期疗效两组差异无统计学意义.结论：应用U形可折断椎弓根螺钉小切口微创内固定治疗胸腰椎骨折疗效好,具有微创、出血少、术后恢复快等优势,且无需特殊器械,不增加X线暴露.

Objective： To investigate the clinical outcome of minimal invasive internal fixation with U-shaped break-off pedicle screws through paraspinal muscle sparing approach to treat thoracolumbar fractures, and to discuss its advantages. Methods： From August 2010 to June 2012, we had 40 thoraco- lumber fractures patients （27 males and 13 females）. Their ages ranged from 22 to 60 years. Of the 40 cases, 4 were T11 fractures, 13 T12 fractures, 17 L1 fractures,6 L2 fractures. According to Denis classi- fication, all of them were burst fractures, with vertebral canal compromise less than 1/3. According to AO classification they were type A or type B1 injuries. All the cases had no nerve injury. The patients were randomly divided into two groups. With Group A （20 cases） we took the method of minimal invasive in- ternal fixation with U-shaped break-off pedicle screws to fix one level above and below the injured verte- bra through the parespinal muscle sparing approach. With Group B （20 cases）, we took the traditional posterior midline approach and open procedure. Then we compared the two groups by operation time, blood loss, drainage, Visual Analogue Scales and X-ray exposure. Results： Minimal invasive group had obvious advatages in operation time, bleeding control and early pain relief of post-operation. The X-ray exposure and long-term follow-up outcome were almost the same. Conclusion： Through paraspinal mus- cle sparing approach minimal invasive internal fixtation with U-shaped break-off pedicle screws to treat thoracolumber has more advantages than traditional procedure in blood control and quick recovery. The method needs no special instruments and don＇t increase X-ray exposure.