椎旁肌间隙入路结合伤椎单侧置钉固定治疗胸腰椎骨折

Treatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach

目的:探讨经肌间隙入路伤椎单侧置钉联合短节段椎弓根螺钉复位固定治疗胸腰椎骨折的可行性及临床疗效。方法:自2006年1月至2009年1月经肌间隙入路伤椎单侧置钉联合短节段椎弓根螺钉复位固定治疗无神经损伤表现胸腰椎单节段骨折21例,男14例,女7例;年龄21~65岁,平均36.4岁;受伤至手术时间为6 h^5 d,平均3 d。依据Denis骨折分型:压缩型骨折12例,爆裂型骨折9例。神经功能按Frankel分级均为E级。骨折部位:T5骨折1例,T7骨折2例,T10骨折2例,T11骨折3例,T12骨折8例,L1骨折5例。依据患者伤椎前缘高度比、矢状面Cobb角、视觉模拟量表(VAS)评分及内固定失败情况进行疗效评价。结果:所有患者获得随访,时间12~36个月,平均20.5个月,内固定无松动、断裂。术前、术后3 d、末次随访时伤椎前缘高度比分别为54.3±2.8、92.9±1.5、93.8±1.7;矢状面Cobb角分别为(27.8±2.5)°、(5.3±0.8)°、(6.3±1.4)°;差异均有统计学意义(P<0.05)。随访期间伤椎前缘高度及Cobb角无明显丢失,末次随访时VAS评分也明显改善(P<0.05)。结论:经肌间隙入路创伤小,失血量少,可完整保留脊柱后方复合体结构,加强脊柱的稳定性,同时伤椎单侧置钉方法安全可靠,并且可提高骨折椎体复位效果和质量,改善固定强度及弥散应力分布。

Objective：To evaluate the feasibility and efficacy of unilateral pedicle screw fixation in treating thoracolumbar fractures through paraspinat approach. Methods ：From January 2006 to January 2009,21 patients with single level thora- columbar fracture without neurological symptoms were treated with unilateral pedicle screw fixation through paraspinal ap- proach. There were 14 males and 7 females ,aged from 21 to 65 years old with a mean of 36.4 years. The duration from injury to operation ranged from 6 h to 5 d with an average of 3 d. According to the classification of Denis fracture ,compression fractures happedned in 12 cases and burst fractures happened in 9 cases,including 1 case with T5 fracture,2 cases with T7 fracture,2 cases with Tt0 fracture ,3 cases with T11 fracture ,8 cases with T12 fracture ,and 5 cases with L1 fracture. Based on the Flankel grade, all patients were classified as grade E. Anterior vertebral body height ratio, sagittal Cobb angle, condition of internal fix- ation failure, visual analogue score （VAS） were evaluated. Results：All patients were followed up from 12 to 36 months with an average of 20.5 months. No internal fixation failure was found. Anterior vertebral body height ratios at preoperative 3 days after operation and last follow-up were 54.3±2.8,92.9±1.5,93.8±1.7, respectively ;sagittal Cobb angle at the three timepoints were （27.8±2.5）°, （5.3±0.8）°, （6.3±1.4）° ,respectively;the difference was statistical significant （P〈0.05）. VAS was （1.2±0.4） points at last follow-up and had obviously improved （P〈0.05）. Conclusion：Treatment of thoracolumbar fractures with unilateral pedicle screw fixation through paraspinal approach is safe with the advantages of micro-trauma and less blood loss, which can not only completely retain the posterior spinal complex structure, reinforce the spinal stability, raise the reductional quality, but also improve the strength of fixation and the distribution of stress force.