经皮椎弓根螺钉棒无融合内固定治疗胸腰椎骨折

Percutaneous pedicle screw-rod fixation without fusion for treatment of thoracolumbar fractures

[目的]回顾性分析应用经皮椎弓根螺钉棒无融合内固定治疗胸腰椎骨折的临床疗效。[方法]回顾性分析2014年5月~2015年10月应用经皮椎弓根螺钉非融合固定治疗胸腰椎骨折患者32例,男25例,女7例,年龄18~52岁(平均33.42岁)。其中A1型8例,A3型17例,B2型7例,患者术前均无神经功能障碍。比较术前、术后(术后1周)、最终随访时骨折椎体高度(VBH)、区域后凸角度(RKA),观察患者术后疼痛和功能障碍的恢复情况。[结果]所有患者均成功接受手术,均未出现严重并发症。术后随访12~23个月(平均17.34个月)。术后和最终随访时患者的腰背疼痛(VAS)和Oswestry功能障碍指数(ODI)明显好转,差异具有统计学意义(P<0.05);VBH和RKA均较术前得到良好的恢复(P<0.05),27例患者于术后6~9个月去除内固定装置后,VBH有一定的下降(平均1.71 mm),RKA有一定增加(平均2.88°)。[结论]经皮椎弓根钉对胸腰段压缩性骨折以及部分爆裂性骨折、屈曲牵张损伤具有良好的疗效。

[Objective] To assess the outcomes of thoracolumbar fractures treated with percutaneous pedicle screw-rod fixation without fusion. [Methods] A retrospective study was conducted on 32 patients with thoraeolumbar fractures treated with percutaneous pedicle screw-rod fixation without fusion from May 2014 to Oct 2015, including 25 males, and 7 females aged from 18 to 52 years with an average of 33.42 years. All the patients proved neurologically intact before operation. Regarding to AO classification, 8 patients were type AI, 17 were type A3, and the other 7 were type B2. The VAS and ODI, as well as radio- logical parameters, such as vertebral body height （VBH） and segment kyphotie angle （RKA） , were measured for evaluation of outcome. [Results] All patients had surgeries successfully conducted without severe complication in any of them. The patients were followed up from 12 to 22 months with an average of 17.34 months. Both VAS and ODI significantly improved after opera- tion and at the latest follow up compared to those before operation （P〈0.05）. Similarly, the VBH and RKA were well restored by comparison of the data postoperatively with those preoperatively （P〈0.05） . The VBH slightly decreased （1.71 mm on average） , while the RKA slightly increased （2.88~on average） after instruments were removed in 27 of the 32 patients at 6 to 9 months postoperatively. [Conclusion] The percutaneous pedicle screw-rod fixation without fusion is effective treatment for thoracolum- bar fracture, especially for the compressive, partially burst and flexion-distraction type of fracture.