韧带复位法经皮椎弓根钉固定治疗单节段胸腰椎A型骨折

Ligamentotaxis combined with percutaneous pedicle screw fixation for single level type A thoracolumbar fracture

[目的]探讨单节段胸腰段椎体A型骨折的微创复位和固定技术及其临床效果。[方法]前瞻性研究2013年2月～2017年3月本院收治的胸腰段椎体骨折患者85例,均为单节段且无神经损伤症状,依据随机数字表法将患者分成两组,均采取微创手术治疗方式,43例采用韧带复位+经皮椎弓根钉固定(韧带组),42例采用为体位复位+经皮椎弓根钉固定(体位组)。记录并分析患者术前及术后疼痛视觉模拟量表评分(VAS)、Oswestry功能障碍指数(ODI)、椎体前缘相对高度、矢状位椎体后凸Cobb角等指标。[结果] 85例患者获得6～19个月随访,平均随访时间(12.25±3.03)个月。术后相应时间点两组间VAS评分差异无统计学意义(P>0.05)。虽然术后1个月时两组间ODI的差异并无统计学意义(P>0.05),但是术后6个月及末次随访时,韧带组的ODI显著小于体位组,差异有统计学意义(P<0.05)。在影像测量方面,术后相应时间点韧带组的后凸Cobb角均小于体位组,但差异无统计学意义(P>0.05)。术后1、6个月和末次随访时,韧带组的椎体前缘相对高度均显著大于体位组,差异均有统计学意义(P<0.05)。[结论]经皮椎弓根钉固定治疗胸腰段椎体A型骨折是有效的微创手术方式,具有手术损伤小、恢复期短等明显优势,结合韧带复位法可以进一步提高椎体复位程度,相比传统的体位复位法能够达到更好的临床效果。

[Objective] To explore the clinical outcomes of a minimally invasive surgical techniques for single level type A thoracolumbar fracture. [Method] From February 2013 to March 2017, 85 patients with a single level thoracolumbar fracture without nerve injuries were enrolled into this randomized prospective study. All the patients, divided into two groups based on the random number table, underwent minimally invasive spinal surgery. Of them, 43 patients received ligamentotaxis combined with percutaneous pedicle screw fixation （the LT group）, while the remaining 42 patients had postural reduction combined with percutaneous pedicle screw fixation （The PR group） . The visual analogue scale （VAS） of pain and Oswestry Disability Index （ODI） were used for evaluation of clinical outcomes, additionally, radiographic measures, such as Cobb angle of kyphosis and relative anterior height of the involved vertebra, were conducted to assess the fracture reduction. [Results] All patients were followed up for 6 to 19 months with an average of （12.25±3.03） months. There were no statistically significant differences regarding to VAS between the two group at any corresponding postoperative time point （P〉0.05）. Although no statistically significant difference in ODI between them was proved at 1 month postoperatively, the LT group got statistically significantly less ODI than the PR group at 6 months after operation and the latest follow up （P〈0.05）. In term of radiographic measures, the LT group had less Cobb angles after operation than the PR group, despite no statistical differences between the two groups （P〉0.05）. However, the LT group got statistically greater relative anterior height of the involved vertebrae than the PR group at 1, 6 months and the latest follow up （P〈0.05）. [Conclusions] Percutaneous pedicle screw fixation is effective minimal invasive interference to type A thoracolumbar fracture, with benefits of minimized operative trauma and facilitated functional recovery. Combined with ligamentotaxis simultaneously, the fracture reduction and clinical outcomes are further improve d compared with the traditional postural reduction.