经皮微创单向实心椎弓根钉内固定治疗胸腰椎骨折

Treatment of thoracolumbar vertebral fractures with percutaneous pedicle screw fixation

背景:传统开放手术方式治疗脊柱胸腰段骨折会对患者造成较大创伤,有加速脊柱局部退变可能。新的微创手术方式减小了患者创伤,患者能得到更好的恢复,对传统手术提出挑战。目的:探讨经皮微创单向固定实心椎弓根钉植入内固定治疗胸腰椎骨折的操作要点和注意事项。方法:选择行经皮微创单向实心椎弓根钉内固定治疗单一胸腰椎骨折不伴有脊髓损伤患者27例,其中24例患者骨折椎体高度恢复良好,另3例通过适度加大椎弓根钉链接棒弧度辅助抗扭矩套筒套于椎弓根钉尾冒以后柱为支点张开脊柱前柱得到良好复位。观察手术时间、术中出血量,内固定前1d轴向翻身目测类比评分、内固定后第1天术区目测类比评分、内固定后第3天术区及轴向翻身目测类比评分。结果与结论:①27例患者108个椎体均在靶点细针参照法引导下经椎弓根途径穿刺置钉,穿刺顺利,98个椎体一次性穿刺成功,余10个椎体二次调整进针点穿刺置钉成功;②内固定后第3天轴向翻身目测类比评分显著低于内固定前1天(P<0.001);内固定后第3天术区目测类比评分显著低于内固定后第1天(P<0.001);③手术时间及经皮单向实心椎弓根钉内固定手术时间平均(109±18)min;术中出血平均(60±16)mL;④术后无神经根损害并发症发生;(5)结果说明,经皮单向实心椎弓根植入固定治疗不伴有脊髓损伤及椎间盘严重受损的单一胸腰椎骨折的微创手术方式有效且安全;靶点细针参照引导穿刺技术作为简单易行的方法能够显著降低经椎弓根途径的穿刺难度,具有极高的一次性穿刺成功率。

BACKGROUND： Traditional open surgery will do great damage to the patients with thoracolumbar fractures, and easily induces local degeneration. In contrast, the novel method is minimally invasive, which contributes to the functional recovery of the spine.OBJECTIVE： To discuss the essential procedures and precautions in the treatment of thoracolumbar fractures with percutaneous pedicle screw fixation.METHODS： Twenty-seven cases of single-level thoracolumbar fractures without spinal neurological deficits treated with percutaneous pedicle screw fixation were selected. The operation time and intraoperative blood loss were observed. The Visual Analogue Scale scores during axial turning at baseline and 3 days postoperatively, and the Visual Analogue Scale scores of the operation region at 1 and 3 days postoperatively were detected, respectively.RESULTS AND CONCLUSION： （1） Twenty-seven patients with 108 vertebrae underwent percutaneous pedicle screw fixation under the guidance of the needle, the puncture was smooth, 98 vertebrae was punctured successfully once, and 10 vertebrae were punctured successfully twice. （2） The Visual Analogue Scale scores during axial turning at 3 days postoperatively were significantly lower than those at baseline, and the scores of the operation region at 3 days postoperatively were significantly lower than those at 1 day postoperatively （P 〈 0.001）. （3） The mean operation time was （109±18） minutes, and the mean intraoperative blood loss was （60±16） mL. （4） There were no nerve root injury and other complications. （5） Our results indicate that percutaneou pedicle screw fixation is a minimally invasive and safe method to treat the patients suffering single-level thoracolumbar fractures without spinal neurological deficits.