经皮椎弓根螺钉内固定并伤椎单侧置钉修复单节段胸腰椎骨折

Percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for treating single segment of thoracolumbar fracture

背景:研究表明,经皮椎弓根螺钉内固定治疗胸腰椎骨折可以获得较好的治疗效果,但对于伤椎是否置入螺钉及单侧还是双侧置入尚存在争议。目的:观察经皮椎弓根螺钉内固定并伤椎单侧置钉治疗单节段胸腰椎骨折的效果。方法:纳入单节段胸腰椎骨折患者21例,其中男16例,女5例,涉及T11 2例、T12 4例、L1 13例、L2 2例,均行经皮椎弓根螺钉内固定并伤椎单侧置钉治疗。随访观察治疗前后的目测类比评分、腰椎功能JOA评分、Cobb角及并发症。结果与结论:(1)目测类比评分:患者治疗后1周、3个月、6个月、12个月的目测类比评分均低于治疗前(P<0.001),治疗后1周的目测类比评分明显低于治疗后3,6,12个月(P<0.001);治疗后3,6,12个月目测类比评分比较差异无显著性意义;(2)腰椎功能:患者治疗后1周、12个月的JOA评分均高于治疗前(P<0.001),治疗后12个月的JOA评分高于治疗后1周(P<0.001);(3)Cobb角:患者治疗后1周、12个月的Cobb角均低于治疗前(P<0.001),治疗后1周、12个月的Cobb角比较差异无显著性意义;(4)并发症:治疗中及治疗后均未发生任何并发症;(5)结果表明:经皮椎弓根螺钉内固定并伤椎单侧置钉治疗单节段胸腰椎骨折可快速矫正后凸畸形,改善胸腰椎功能,快速缓解患者腰背部疼痛,具有较高的安全性。

BACKGROUND： Studies have shown that percutaneous pedicle screw internal fixation for treatment of thoracolumbar fracture has got good clinical results, but for the injured vertebra body, whether pedicle screw should be implanted in injured vertebra body and unilateral or bilateral implanting screw is still controversial.OBJECTIVE： To investigate the clinical efficacy of the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for treatment of single segment of thoracolumbar fracture. METHODS： Totally 21 patients with single segment thoracolumbar fractures were treated by the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body, including 16 males and 5 females. There were T11 in 2 cases, T12 in 4 cases, L1 in 13 cases, and L2 in 2 cases. The Visual Analog Scale scores（VAS）, the Japanese Orthopaedic Association（JOA） disability scores and Cobb＇s angle were recorded preoperatively and postoperatively. In addition, complications were also recorded. RESULTS AND CONCLUSION：（1） The VAS scores at 1 week and 3, 6 and 12 months after treatment were significantly lower than those before surgery（P〈0.001）. In addition, VAS scores were lower at 1 week than that at postoperative 3, 6, 12 months（P〈0.001）. No significant difference in VAS scores was detected at postoperative 3, 6, 12 months.（2） Lumbar function： JOA scores were significantly higher at postoperative 1 week and 12 months than those before treatment（P〈0.001）, and the postoperative JOA scores were significantly higher at 12 months than at postoperative 1 week（P〈0.001）.（3） Cobb＇s angle was significantly smaller at 1 week and 12 months after surgery than that before treatment（P〈0.001）. No significant difference in Cobb＇s angle was detectable at 1 week and 12 months after surgery.（4） No complications were found.（5） These results suggest that the percutaneous pedicle screw internal fixation combined with pedicle screw implanting in injured vertebra body for single segment of thoracolumbar fracture can correct kyphosis, improve the thoracolumbar motion, quickly relieve patient＇s back pain, and is very safe.