微创长尾U形空心椎弓根钉联合伤椎置钉治疗胸腰椎骨折

Percutaneous minimally invasive novel perfusional pedicle screw (PMINPPS) and additional injured vertebrae screw fixation for treatment of thoracolumbar fractures

目的探讨微创长尾U形空心椎弓根钉联合伤椎置钉治疗胸腰椎骨折的疗效。方法2012年6月～2015年1月，我科对30例T12～L3单节段胸腰椎骨折患者行微创长尾U形空心椎弓根钉联合伤椎置钉治疗，对手术时间、术中出血量、切口总长度、手术前后伤椎前缘高度、后凸Cobb角、矢状面指数等观察指标进行统计学分析。结果手术切口长度为（5．36±1．04）cm，时间为（89．28±4．36）min，术中出血量为（56．78±11．79）mL，患者术后疼痛均明显缓解。所有随访病例在术后1d、术后6个月的伤椎椎体前缘高度、Cobbs角、椎体压缩程度、椎管骨块占位率与术前比较，差异均有统计学意义（P〈0．05），手术后1d与术后6个月伤椎椎体前缘高度、Cobbs角、椎体压缩程度、椎管骨块占位率相比较，差异均有统计学意义（P〉0．05）。均无发生切口感染、退钉及断钉等并发症。结论微创长尾U形空心椎弓根钉联合伤椎置钉治疗胸腰椎骨折具有创伤小、出血少、疗效确切等优势，值得临床推广应用。

Objective To explore clinical effect of the treatment of thoracolumbar fractures with Percutaneous minimally invasive novel perfusional pedicle screw （PMI-NPPS）and additional injured vertebrae screw fixation. Methods There were 30 patients with T11-L3 single segment vertebral fractures treated with PMI-NPPS combined with injured vertebrae screw fixation from Jun 2012 to Jan 2015. Operative time, blood loss, the total length of the incision, pre-operative and postoperative anterior height of the injured vertebrae, Cobb angle and sagittal index were collected for statistical analysis. Results The total length of the incision was （5.36±1.04） cm, operative time was （89.28±4.36） min, blood loss was （56.78± 11.79） mL. The postoperative pain of the patients was significantly alleviated. Cobb angle and sagittal index of one day and 6 months after operation were all significantly improved than pre-operation （P〈0.05）. The differences of anterior height of the injured vertebrae, Cobb angle and sagittal index of one day after operation were not statisticaly significant（P〈0.05）. There had maintained well at final follow-up without internal fixation failure （P〉0.05）. Conclusion It is exactly certain that the treatment of PMI-NPPS combined with injured vertebrae screw fixation for thoracolumbar fractures is effective. It is worth popularizing in clinical application.