椎板开窗减压结合肌间隙入路置钉治疗伴神经损伤胸腰椎爆裂骨折

Minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation for thoracolumbar burst fractures with neurologic injury

目的 探讨小切口椎板开窗行椎管减压,结合椎旁肌间隙入路置钉治疗伴神经损伤胸腰椎爆裂骨折手术疗效。方法 回顾研究自2013年1月至2016年2月采用小切口椎板开窗椎管减压＋椎旁肌间置钉内固定治疗33例合并神经损伤的胸腰椎爆裂骨折。结果 33例获得2~36个月随访,平均17个月,手术时间短,术中及术后出血量少,腰背部疼痛均优于传统后正中手术,术后椎体高度、Cobb角矫正率、椎管狭窄及神经功能情况,均有不同程度恢复。结论 小切口椎板开窗减压＋肌间隙置钉治疗合并神经损伤胸腰椎爆裂骨折与传统后正中手术具有相同疗效,具有手术时间短,创伤小,出血量少,术后患者恢复快,保留了脊柱结构和稳定性,而且可以使椎管得到有效减压。

Objective To explore the efficacy of minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation for the treatment of thoracolumbar burst fractures with neurologic injury. Methods From January 2013 to February 2016, 33 cases of thoracolumbar burst fractures with neurologic injury were treated with minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation. Result 33 patients were followed up for 2-36 months,with an average of 17 months. Compared with the conventional surgical approach, shorter operative time,less intraoperative and postoperative bleeding,milder back pain were resulted using the surgical approach described in this paper. There were varying degree of recovery of vertebral height,,Cobb angle correction rate,spinal stenosis and neurological conditions. Conclusion Minimally invasive fenestration canal decompression and gap muscle pedicle screw fixation for treatment of thoracolumbar burst fractures with neurologic injuryhas the advantages of enjoying a shorter operative time,less trauma,less bleeding,rapid postoperative recovery,as well as retaining the structure and stability of the spine, resulting in effective reduction of pressure within the spinal canal.