微创经皮椎弓根置钉治疗无神经损伤胸腰椎骨折

Treatment of thoracolumbar fractures witnout neural injury by minimal-invasive percutaneous pedicle screw fixation

目的探讨微创经皮椎弓根螺钉内固定术治疗无神经损伤性胸腰椎骨折的手术方法及临床疗效。方法回顾性分析蚌埠医学院第二附属医院2012年2月—2013年10月采用微创经皮椎弓根螺钉内固定技术治疗无神经损伤性胸腰椎骨折18例。其中男性12例，女性6例，年龄25—56岁，平均41岁，T11椎体骨折2例、T12椎体骨折5例、L1椎体骨折7例、L2椎体骨折4例，车祸伤7例，重物砸伤3例，高处坠落伤8例。脊柱骨折按AO分型均为A型骨折，无脊髓或神经根损伤的临床表现。测定手术前后患者的伤椎前缘高度及Cobb角，并作统计分析。结果18例患者均获随访，随访时间6～18个月，平均13个月。手术切口均为4个长约1．5～2．0cm的皮肤切口，远较常规腰椎后路开放手术为小；术中出血量约60～100ml，远较常规腰椎后路开放手术为少；均于术后2周腰痛明显缓解后带支具下床，术后患者的伤椎前缘高度及Cobb角均有所恢复，且较术前差异有统计学意义（P〈0．05）。无脊髓神经损伤、切口感染、不愈合、腰背肌疼痛、椎弓根螺钉断裂等并发症发生。结论微创经皮椎弓根螺钉内固定术治疗无神经损伤性胸腰椎骨折，创伤小、出血少、恢复好、并发症少，值得临床进一步推广和应用。

Objective To investigate the surgical method and clinical effect of thoracolumbar fractures witnout neural injury treated by minimal-invasive percutaneous pedicle screw fixation. Methods 18 cases of thoracolumbar fractures witnout neural injury treated by minimal-invasive percutaneous pedicle screw fixation that could he followed up during February 2012 to October 2013 in my hospital were retrospectively analyzed. There were 12 males and 6 females with an average age of 41 years（ranging from 25 to 56 years）. There were 2 cases Tll fractures,5 cases T12 fractures,7 cases L1 fractures, and 4 cases L2 fractures. There were 7 cases fractures for traffic accidents,3 cases fractures for heavy pound injury, 8 cases fractures for high fall. According to AO type： they were type A thoracolumbar fractures without neural injury. Anterior vertebral height and Cobb angle was surveyed and analyzed before and after the operation. Results All the patients were followed up for a mean time of 13 months （ranging from 6 to 18 months）. The anterior vertebral height and Cobb angle restored after the operation. There were statistical significance in the data （ P 〈 0.05 ）. There was not any complication happened in these groups, such as neural injury, infection, disunion, back muscle pain and screw breakage. Conclusion Minimal-invasive percutaneous pedicle screw fixation was a good method to treat thoracolumbar fractures without neural injury, because of its less trauma, less bleeding, better recovery and less complication. Thus it was worthy of application and popularized clinical promotion.