微创通道下减压结合经皮螺钉复位固定治疗伴有神经根损伤的胸腰椎骨折

Minimally invasive decompression and fixation with percutaneous pedicle screw for thoracolumbar fracture with nerve root injury

目的探讨在微创通道下减压结合经皮椎弓根螺钉复位内固定治疗伴有神经根损伤的胸腰椎骨折的可行性及疗效。方法 2012年1月-2014年7月本院收治不同节段胸腰椎骨折伴有神经根损伤患者30例,采用微创通道下神经根减压结合经皮螺钉复位内固定治疗。其中男18例,女12例;年龄28-61岁,平均42岁。骨折节段及神经根损伤节段为T11-L3,均为单节段神经根不完全损伤,无脊髓、圆锥或马尾损伤。测量术前、术后及末次随访时伤椎前缘相对高度及Cobb角,评价骨折椎体复位情况。采用日本骨科学会（Japanese Orthopaedic Association,JOA）评分（29分）评价术前、术后及末次随访时患者的神经功能。结果所有患者均手术顺利,无明显手术并发症。随访12-42个月,平均27个月。术后X线片提示螺钉位置满意。末次随访X线片提示所有螺钉无错位且无断钉。术后及末次随访时的伤椎前缘相对高度、Cobb角、JOA评分与术前相比,差异均具有统计学意义（P〈0.05）。结论微创通道下减压结合经皮螺钉复位内固定术治疗伴有神经根损伤的胸腰椎骨折临床效果满意,且创伤小、恢复快、并发症少,安全可靠。

objective To evaluate the feasibility and efficacy of minimally invasive decompression and fixation with percutaneous pedicle screw in the treatment of thoracolumbar fracture with nerve root injury. Methods From January 2012 to July 2014,30 patients of thoracolumbar fracture with nerve root injury were treated with minimally invasive decompression and fixation with percutaneous pedicle screw. The 30 patients（ 18 males and 12 females）,ages ranged from 28 to 61（ mean 42 years old）. Fracture segments were T11-L3. All the cases suffered from single segment incomplete nerve root injury,without injury of spinal cord,cone and cauda equina. The mean follow-up period was 20 months. The relative height of anterior border and Cobb＇s angle were recorded to evaluate vertebrae reposition condition. Japanese Orthopedic Association（ JOA） scores were recorded at pre-operation,post-operation and final follow-up to evaluate neurological function recovery condition.Results All the patients underwent surgery successfully,and no obvious complications were observed. The follow-up time ranged 12-42 months,mean 27 months. The postoperative roentgenographs suggested that all pedicle screw positions were satisfactory. The roentgenographs at final follow-up did not suggest any pedicle screw malpositioning or breakage. Compared with those of the pre-operation,the postoperative relative height of anterior border,Cobb＇s angle and JOA score were significantly improved; the differences had statistical significance（ P〈0. 05）. Conclusion Minimally invasive decompression and fixation with percutaneous pedicle screw in the treatment of thoracolumbar fracture with nerve root injury has satisfactory effectiveness. And it has the advantages of minimal trauma,quick recovery,less complications,safeness and reliableness.