微创经皮椎弓根钉治疗A型胸腰椎跳跃性骨折的疗效分析

Therapeutic effect of minimally invasive percutaneous pedicle screw in the treatment of type A thoracolumbar jumping fracture

目的探讨微创经皮椎弓根钉治疗A型胸腰椎跳跃性骨折的临床疗效。方法对我院2010年1月～2017年12月期间应用微创经皮椎弓根钉治疗两节段胸腰椎跳跃性骨折并得到密切随访的36例患者进行回顾性分析,无神经功能改变,按Frankel功能评定均为A级,手术均采用微创经皮椎弓根钉固定治疗,分析患者手术切口长度、手术时间、术中出血量及术前、术后3 d、6个月的伤椎椎体前缘高度、矢状面Cobb角、椎管占位率。结果所有患者内固定手术均顺利完成,手术切口总长度(12.45±1.56)cm,术中出血量(88.58±12.86)mL,手术时间(105.68±10.24)min。所有患者获得8～13个月,平均12个月的随访。伤椎椎体前缘高度、矢状面Cobb角、椎管占位率术后与术前比较,差异具有统计学意义(P<0.05),而术后3 d与术后6个月比较,差异无统计学意义(P>0.05)。所有患者术后6个月均无明显的腰背部疼痛、退钉及断钉等并发症。结论应用微创经皮椎弓根钉治疗A型胸腰椎跳跃性骨折,创伤小、并发症少,能取得满意的疗效。

Objective To investigate the clinical efficacy of minimally invasive percutaneous pedicle screw fixation for type A thoracolumbar jumping fracture.Methods A retrospective analysis of36patients with two-segment thoracolumbar vertebral fractures treated with minimally invasive percutaneous pedicle screw in our hospital from January2010to December2017was performed.There were no neurological changes.All patients were grade A according to Frankel function.All patients underwent minimally invasive percutaneous pedicle screw fixation.The length of surgical incision,operation time,intraoperative blood loss and the height of the vertebral body leading edge before surgery,at3days and6months after surgery,the sagittal Cobb angle,and the spinal canal occupancy rate were analyzed.Results All patients underwent internal fixation successfully.The total length of the incision was(12.45±1.56)cm,the intraoperative blood loss was(88.58±12.86)mL,and the operation time was(105.68±10.24)min.All patients received8to13months with an average of12months of follow-up.There was significant difference in the height of the vertebral body of the injured vertebrae,the Cobb angle of the sagittal plane,and the occupational rate of the spinal canal before and after surgery(P<0.05).There was no significant difference between3days after surgery and6months after surgery(P>0.05).All patients had no obvious complications such as low back pain,nail retraction and broken nails at6months after operation.Conclusion Minimally invasive percutaneous pedicle screw fixation for type A thoracolumbar jumping fractures has less trauma and less complications,and can achieve satisfactory results.