Ⅰ期后路椎弓根螺钉固定结合经椎弓根椎体间植骨融合治疗C型胸腰椎骨折

One stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft for type C thoracolumbar fractures

目的通过与Ⅰ期前后路联合手术进行比较，探讨Ⅰ期后路椎弓根螺钉固定结合经椎弓根椎体间植骨融合术治疗C型胸腰椎骨折的临床疗效。方法采用回顾性病例对照研究分析2012年1月-2015年12月收治的40例C型胸腰椎骨折患者临床资料，其中男28例，女12例；年龄20～48岁，平均30．6岁。损伤节段：T11 4例，T12 16例，L1 14例，L2 6例。根据治疗方法分为I期后路椎弓根螺钉固定结合后外侧椎体间植骨融合术治疗组（后路组）和Ⅰ期前后路联合手术治疗组（前后联合组），每组20例。比较两组围术期相关指标、椎体前缘高度比、后凸Cobb角、腰背痛视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）等。在胸腰椎CT上评估植骨融合情况。结果所有患者术后随访10～46个月，平均28．6个月。后路组：平均手术时间154min，术中出血量564ml，术后引流量180．5ml，下床时间5．9d，住院时间10．6d；前后联合组：平均手术时间248．5min，出血量960．8ml，术后引流量359．2ml，下床时间8．4d，住院时间14．5d（P均〈0．05）。后路组和前后联合组术后1周和术后6个月随访时椎体前缘高度比、后凸Cobb角、VAS及ODI均较术前明显改善（P〈0．05），除术后1周疼痛外，两组间其他各项参数比较差异无统计学意义（P〉0．05）。两组术后6个周均获得骨性融合，但差异无统计学意义（P〉0．05）。结论Ⅰ期后路椎弓根螺钉固定结合经椎弓根椎体间植骨融合技术通过单一后方入路能同时完成骨折椎体复位、脊髓减压、前中柱稳定性重建，与传统前后路联合手术相比，具有操作更简单、手术创伤更小、术后恢复更快等优点，并且骨性融合效果相当，是治疗C型胸腰椎骨折可供选择的技术。

Objective To evaluate the therapeutic effect of one stage posterior pedicle screw fixation combined with transpediele intervertebrae titanic mesh autograft versus traditional posterior and anterior approach surgery in the treatment of severe thoracolumbar fractures. Methods A retrospective case-control study was done on 40 cases of type C thoracolumhar fractures admitted from January 2012 to December 2015. There were 28 males and 12 females, with age range of 20-48 years （mean, 30.6 years）. The fractures were located at T11 in 4 cases, at T12 in 16, at L1 in 14,and at L2 in 6. All cases were divided into two groups （with 20 cases per group ） according to treatment method difference. The eases in posterior group had one stage posterior pediele screw fixation combined with transpediele intervertebrae titanic mesh autograft, and the others in posterior and anterior group were treated by traditional posterior and anterior approach surgery . The operation duration, volume of blood loss, hospital stay, kyphosis correction rate, visual analogue scale （VAS） and Oswestry disability index （ ODI ） were compared between the two groups. Results All patients were followed up for 10-46 months （ mean, 28.6 months）. In posterior group, the average operation time was 154 minutes, the average blood loss was 564 ml, the postoperative suction drainage was 180.5 ml, the time period between surgery and recovery of walking ability was 5.9 days, and the hospital stay was 10.6 days. While in posterior and anterior group, the average operation time was 248.5 minutes, with the average blood loss of 960.8 ml, the postoperative suction drainage of 359.2 ml, the time duration between surgery and recovery of walking ability of 8.4 days, and the hospital stay of 14.5 days （ P 〈 0.05 ）. At one week and six months postoperatively, the height ratio of anterior edge, Cobb angle, VAS and ODI in both groups were improved compared to the preoperative status （ P 〈 0.05 ）. But there was no significant difference of these indicators between two groups （ P 〉 0.05 ） except for lumbar back pain one week after operation （ P 〉 0. 05 ）. Conclusions Through single pathway of posterior approach, one stage posterior pedicle screw fixation combined with transpedicle intervertebrae titanic mesh autograft can complete reduction of fractured vertebral body, spinal cord decompression, and anterior-middle column stability reconstruction. Compared with traditional combined posterior and anterior approach surgery, this technique has many advantages including simpler manipulation, less invasion, shorter rehabilitation time and equal bony fusion and hence is an ideal option for type C thoracolnmbar fractures.