Sextant内固定系统修复腰椎骨折:伤椎前后缘高度比及后凸Cobb角变化

Sextant system fixation for the repair of lumbar fracture: ratio of anterior to posterior border height of the injured vertebra and kyphosis Cobb angle

背景:腰椎后路椎弓根螺钉内固定已成为腰椎压缩性骨折常见的治疗方式之一,传统手术切开行椎弓根螺钉内固定通常产生较多局部肌肉组织的损伤,在微创下进行腰椎内固定是脊柱微创外科的一大进展。目的:探讨经皮微创Sextant内固定系统修复腰椎骨折的临床效果,对比观察内固定前后患者目测类比评分、伤椎前后缘高度比以及脊柱后凸Cobb角变化。方法:选择58例腰椎压缩骨折患者资料进行回顾性分析。所有病例均由同一高年资骨科副主任医师(第二作者)于2008年1月至2013年12月在成都市第一人民医院骨科完成。均行经后路腰椎Sextant系统内固定。主要观察术中失血量,内固定前后目测类比评分、伤椎前后缘高度比以及脊柱后凸Cobb角变化。结果与结论:术中平均出血量40 m L,内固定后平均引流量80 m L,内固定后患者腰背部疼痛明显缓解(P<0.01),平均卧床2周即可下地行早期功能康复锻炼。内固定后伤椎前后缘高度比及后凸Cobb角均较内固定前有明显改善(P<0.05),未出现螺钉松动、断裂。说明经后路腰椎Sextant系统内固定修复腰椎压缩性骨折,能够较好的恢复椎体前缘高度、矫正脊柱后凸,并且失血量少,内固定后疼痛症状轻,便于患者术后早期功能锻炼。

BACKGROUND：Posterior lumbar pedicle screw fixation has been a common method to treat vertebral compression fractures. Traditional surgical incision of pedicle screw fixation commonly produces many local muscle tissue damages. Lumbar fixation by minimaly invasive method is a big progress in minimaly invasive spine surgery. OBJECTIVE：To investigate the therapeutic results of Sextant system with percutaneous pedicle screw fixation for the treatment of lumbar fracture, and to compare the changes in visual analog scale, the ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle before and after fixation. METHODS：Data of 58 cases of vertebral compression fractures were retrospectively analyzed. Al cases were treated by the senior associate chief physician （second author） at the Department of Orthopedics, the First People’s Hospital of Chengdu from January 2008 to December 2013. They received Sextant system with percutaneous pedicle screw fixation. Intraoperative blood loss, the changes in visual analog scale, the ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle before and after fixation were observed. RESULTS AND CONCLUSION： The average blood loss during the surgery was 40 mL, with an average post-surgery drainage of 80 mL. Postoperative lumbar back pain was significantly reduced （P 〈 0.01）. After 2＆nbsp;weeks of lying in bed, they could do early functional rehabilitation exercises. The ratio of anterior to posterior border height of the injured vertebra, and kyphosis Cobb angle were significantly improved after fixation （P 〈 0.05）. There was no screw loosening or breakage. These data suggested that the Sextant system with percutaneous pedicle screw fixation for vertebral compression fractures can better restore the anterior border height and correct kyphosis. Moreover, blood loss is less. Pain became mild after fixation, which is convenient to early functional exercises after the surgery.