经皮间接减压内固定术治疗伴有神经损伤的胸腰椎爆裂性骨折

Percutaneous indirect decompression and internal fixation for treatment of thoracolumbar burst fracture with nerve injury

目的探讨后路经皮间接减压内固定术治疗伴有神经损伤的胸腰椎爆裂性骨折的有效性及安全性。方法 2015年6月—2017年6月,共25例伴神经损伤的胸腰椎爆裂性骨折患者接受后路经皮间接减压内固定术治疗。采用Frankel分级评估神经功能等级,采用疼痛视觉模拟量表(VAS)评分评估腰背部疼痛程度。测量并记录术前、术后及末次随访时矢状位Cobb角、伤椎椎体前缘高度百分比、伤椎楔形角、椎管占位率等影像学指标。结果所有患者手术均顺利完成,随访6～24(12.6±5.6)个月,末次随访时所有患者腰背部疼痛症状均明显改善,椎管得到有效减压,神经功能均明显改善,椎体骨折复位愈合,随访无明显丢失,无内固定相关并发症发生。结论后路经皮间接减压内固定术可避免椎管内直接减压,保护脊柱后方结构,减少手术创伤,临床疗效满意,对于伴有不完全神经损伤的胸腰椎爆裂性骨折的治疗是一种微创、安全、有效的选择。

Objective To investigate the efficacy and safety of posterior percutaneous indirect decompression and internal fixation for thoracolumbar burst fractures with nerve injury.Methods From June 2015 to June 2017,25 patients with thoracolumbar burst fractures with nerve injury underwent posterior indirect decompression and internal fixation.Neurological function was assessed by Frankel classification,and visual analogue scale(VAS)score was used to assess the degree of low back pain.The sagittal Cobb’s angle,percentage of anterior vertebral height of injured vertebrae,wedge angle of injured vertebrae,and spinal canal occupying rate were measured and recorded at preoperative,postoperative and final follow-up.Results All the patients underwent surgery successfully.The follow-up time was 6-24(12.6±5.6)months.At the final follow-up,the symptoms of low back pain were significantly improved;the spinal canal was effectively decompressed;the nerve function was significantly improved;the vertebral fracture was reduced and healed without obvious loss;no complications related to internal fixation occurred.Conclusion Posterior percutaneous indirect decompression and internal fixation can avoid direct decompression in the spinal canal,protect the posterior structure of the spine,reduce surgical trauma,and achieve satisfactory clinical results.It is a minimally invasive,safe and effective treatment option for thoracolumbar burst fracture with incomplete nerve injury.