经皮跨伤椎椎弓根置钉伤椎植骨治疗胸腰椎压缩性骨折

Treatment of Thoracolumbar Vertebral Fracture by Percutaneous cross Segment Pedicle Screw and Injured Vertebra Bone Graft

目的探讨经皮跨伤椎椎弓根置钉伤椎植骨治疗胸腰椎压缩性骨折的手术方法及临床疗效。方法 2013年6月至2015年1月采用经皮跨伤椎椎弓根置钉伤椎植骨治疗单节段无神经损伤胸腰椎压缩性骨折20例,其中男6例,女14例;年龄17～67岁,平均43岁。骨折部位：T111例,T124例,L110例,L25例。观察切口长度、出血量、下床时间及并发症发生情况,测量手术前后侧位X线片上伤椎前缘高度及Cobb角并作统计分析。结果 20例均获随访,随访时间9～24个月,平均18个月。单个手术切口长约1.5 cm,出血量平均130 mL,术后2周下床行走,无脊髓神经损伤、切口感染、不愈合、腰背肌疼痛、椎弓根螺钉断裂等并发症发生。术后较术前1周伤椎前缘高度增加、Cobb角减小,手术前后相比差异有统计学意义（P〈0.05）;末次随访与术后1周伤椎前缘高度及Cobb角变化无统计学意义（P〉0.05）。结论经皮跨伤椎椎弓根置钉伤椎植骨术治疗单节段胸腰椎压缩性骨折,能够恢复伤椎高度、矫正脊柱后凸畸形,手术创伤小、出血少、恢复好、远期矫正丢失少。

Objective To investigate the surgical method and clinical effect of thoracolumbar vertebral fractures treated by percutaneous cross segment pedicle screw and injured vertebra bone graft. Methods 20 cases of thoracolumbar vertebral fractures without neural injury treated by percutaneous cross segment pedicle screw and injured vertebra bone graft during June2013 to January 2015. There were 1 cases of T11 fractures,4 cases of T12 fractures,10 cases of L1 fractures,and 5 cases of L2 fractures. Incision length,blood loss volume,time off bed and complications were observed. Anterior vertebral height and Cobb angle were surveyed and analyzed before and after the operation. Results All the patients were followed up for a mean time of18. 0 months（ ranging from 9 to 24 months）. Incision length was about 1. 5 cm. Average blood loss volume was 130 mL. Time off bed was two weeks. There was not any complication happened in this group,such as neural injury,infection,disunion,back muscle pain,screw breakage. When anterior vertebral height and Cobb angle were compared between pre- operation and post- operation,there was significant difference（ P〈0. 05）,but there was no significant difference between one week after operation and final follow- up（ P〈0. 05）. Conclusion The operation of percutaneous cross segment pedicle screw and injured vertebra bone graft is a good method to treat thoracolumbar vertebral fractures,because of its less trauma,less bleeding,better recovery,less correction loss.