经皮微创非融合外固定治疗胸腰椎骨折

Percutaneous transpedicular bone grafting after external spinal skeletal fixation for thoracolumbar burst fracture

目的探讨经皮微创非融合外固定治疗胸腰椎骨折的近期临床疗效。方法收集2013年1月至2013年10月在我院住院治疗的25例胸腰椎骨折患者的临床资料,手术方法均采用脊柱外固定结合伤椎内植骨进行微创非融合治疗,25例中,男15例,女10例。比较术前、术后3 d、3个月及末次随访时的疼痛视觉模拟量表（visual analogue scale,VAS）评分、局部后凸角、椎体高度丢失率,评价该微创术式治疗胸腰椎骨折的近期临床疗效。结果本组患者得到平均14个月的随访（12～22个月）。平均手术时间100 min（60～130 min）,平均术中出血量55 mL（35～120 mL）。仅1例出现皮下感染,经过2周换药后治愈;螺钉弯曲4枚;无椎体感染等发生;平均术后120 d拆除外固定支架;无神经损伤并发症。术后3 d、3个月及末次随访的VAS评分、局部后凸角、椎体前缘高度丢失率与术前比较,差异均有统计学意义（均P〈0.05）。结论经皮微创非融合外固定治疗胸腰椎爆裂性骨折可获得满意的近期疗效。

Objective To evaluate the clinical outcomes of percutaneous transpedicular bone grafting （PTBG） after external spinal skeletal fixation （ESSF） for thoracolumbar fracture. Methods A retrospective review was performed on 25 patients with thoraeolumhar fractures treated by PTBG after ESSF between Jan. 2013 and Oct. 2013 in our hospital. There were 15 males and 10 females in the group. The visual analogue scale （VAS）, local kyphosis angle （LKA）, and vertebral height loss rate were compared to evaluate the treatment outcome. Results All the patients were followed up for an average of 14 months （12-22 months）. The mean operating time was 100 rain （60-130 min）, and the mean blood loss was 55 mL （35-120 mL）. The complications included superior soft infect in 1 case and curved pedicle screw in 4 cases. No vertebral infection occurred. At 120 day after the operation, the external fixator was removed. There was no complication of neural damage. There was significant difference in VAS scores, LKA and vertebral height loss rate before and after operation （P〈0. 05 for all）. Conclusion Additional PTBG after ESSF could get satisfactory outcome in the treatment of thoracolumbar fractures.