后路经皮穿刺空心椎弓根螺钉内固定治疗胸腰椎骨折

Application of posterior percutaneous cannulated pedicle screw fixation in the treatment of thoracolumbar fractures

目的探讨后路经皮穿刺空心椎弓根螺钉内固定治疗胸腰椎骨折可行性及其疗效。方法选择26例损伤平面以下无神经功能损害无需进行椎板减压的单纯胸腰椎骨折患者,Denis三柱分型均为不稳定骨折,后路复位固定手术指针明确。在C臂机定位下行椎弓根穿刺,透视穿刺针,正、侧位片确认位于椎弓根内合适位置,切开皮肤约1.5 cm,依次攻丝,植入万向椎弓根螺钉,撑开、复位和固定。采用视觉模拟疼痛评分（VAS）、功能障碍指数（ODI）以及测量Cobb角评定疗效。结果患者均顺利完成手术,无切口感染、神经根或者脊髓损伤等并发症。手术时间35~80（60±15）min,术中出血量40~110（85±10）ml。患者均获随访,时间18~32个月。VAS术前7.8分±1.1分、术后2.0分±0.6分;Cobb角术前45.1°±3.5°、术后6.3°±3.6°;两项指标与术前比较差异均有统计学意义（P〈0.05）。术后椎体前缘高度及后凸畸形得到矫正。内固定取出后复查X线Cobb角为7.8°±1.4°,与术后比较差异无统计学意义（P=0.52）,椎体高度无明显丢失。术后1个月ODI评分8.0分±0.6分,取出内固定ODI评分6.5分±0.8分（P〈0.05）。术后12~26个月取出内固定,无内固定断裂患者。结论后路经皮穿刺空心椎弓根螺钉内固定技术适合无需减压（或椎管探查）的胸腰椎骨折。

Objective To discuss the feasibility and clinical effects of posterior percutaneous cannulated pedicle screw fixation in the treatment of thoracolumbar fractures. Methods A total 26 cases of pure thoracolumbar fractures without neural impairment were enrolled,who did not need laminotomy decompression. All cases were identified as three column fracture according to Denis classification and needed posterior approach. With the C-arm guiding the pedicle bases of affected segments,then punctured transpedicular,exposed through 4 small incisions（ 1. 5 cm）,drilled with tap,implanted polyaxial pedicle screws and finished with distraction reduction fixation in sequence. Visual analogue scale（ VAS）,Oswestry disability index（ ODI） and Cobb＇s angle were used to assess the effects. Results All operations were completed successfully,and no complications such as incision infection,injuries of nerve root or spinal cord occurred. Operative time was 35 ~ 80（60 ± 15） min,and operative blood loss was 40 ~ 110（85 ± 10）ml. All patients had been followed up for 18 to 32 months. The VAS score had declined from 7. 8 ± 1. 1 preoperatively to 2. 0 ± 0. 6 postoperatively,which had significant statistical difference（ P〈0. 05）. Cobb＇s angle was decreased from 45. 1° ± 3. 5° preoperatively to 6. 3° ± 3. 6° postoperatively,and the difference was significant（ P〈0. 05）. The anterior vertebra height and kyphosis were corrected after surgery. And it was 7. 8° ± 1. 4° after internal fixations removed,which compared to postoperative had no statistical difference（ P = 0. 52）. The vertebra height had scarcely any changed after removal internal fixations. The ODI score was 8. 0 ± 0. 6 one month after surgery and it was 6. 5 ±0. 8 after internal fixations removed（ P〈0. 05）. No breakage occurred until removing internal fixations at 12 ~ 26 months postoperatively. Conclusions Posterior percutaneous cannulated pedicle screw fixation has good effect for the treatment of thoracolumbar fracture which don＇t need laminotomy decompression.