胸腰段骨折相邻伤椎微创置钉适应证选择与疗效分析

Indications and effects of minimally invasive posterior approach single-segmental pedicle screw implantation on thoracolumbar fractures

目的探讨后路相邻伤椎单节段微创置钉治疗胸腰椎骨折适应证及疗效。方法回顾性分析2013-03~2016-11因外伤致胸腰椎骨折但不伴有神经损害症状的21例患者临床资料。CT与MRI均提示无需行椎管减压,所有患者均采用经多裂肌间隙伤椎置钉单节段固定术式。统计术中出血量、手术时间、平均住院时间和术后并发症;术后症状改善用疼痛视觉模拟量表(Visual Analogue Scale,VAS)评分评估;影像学评价通过患者手术前后和末次随访的矢状面后凸Cobb角、伤椎前缘高度丢失率来统计分析。结果所有患者顺利完成手术,术后无内固定失败和医源性神经损害并发症。21例患者中19例获得随访,随访时间8~27(17. 61±5. 12)个月,平均手术时间(84. 28±20. 60) min,平均出血量(140. 51±56. 94) ml,平均住院时间(7. 28±1. 69) d。疼痛VAS评分从术前平均(7. 57±0. 82)分降至术后(2. 78±0. 95)分(P <0. 05),伤椎前缘高度丢失率从术前平均(30. 53±7. 88)%降至术后(5. 52±1. 53)%(P <0. 05),后凸Cobb角从术前平均(18. 47±4. 18)°降至术后平均(5. 84±1. 69)°(P <0. 05)。末次随访VAS评分平均(1. 26±0. 44)分,与术后相比差异有统计学意义(P <0. 05)。末次随访伤椎前缘高度丢失率和后凸Cobb角分别为(7. 26±1. 74)%、(7. 53±1. 98)°,与术后比较差异无统计学意义(P> 0. 05)。结论后路经多裂肌间隙相邻伤椎置钉单节段固定治疗胸腰椎骨折具有创伤小、出血量少、住院时间短等优点,严格把握适应证,该治疗方法临床疗效满意。

Objective To explore the indications and clinical effects of minimally invasive posterior approach single-segmental pedicle screw implantation on treatment of thoracolumbar fractures.Methods Twenty-one cases of thoracolumbar fractures receiving minimally invasive posterior approach single-segmental pedicle screw implantation surgery were collected in our hospital from March 2013 to November 2016 and their clinical data were analyzed retrospectively.CT and MRI showed no need for spinal canal decompression.The evaluations of indicators including intraoperative blood loss,operative time,average hospitalization time,postoperative complications,Visual Analogue Scale(VAS)scores,Cobb′s angle and height loss rate of anterior edge of injured vertebrae were analyzed.Results All the patients had a successful operation.No complications,such as internal fixation failure and nerve damage,were found after surgery.Nineteen patients were followed up and the median follow up was(17.6±5.12)months(ranges from 8 to 27 months).The mean operation time,intraoperative blood loss,and hospitalization time were(84.28±20.60)minutes,(140.51±56.94)ml and(7.28±1.69)days.The VAS scores decreased from preoperative average(7.57±0.82)to postoperative average(2.78±0.95)(P<0.05),the average loss rate of anteriov height of injured vertebrae decreased from(30.53±7.88)%before operation to(5.52±1.53)%after operation(P<0.05),the Cobb′s angle of kyphosis decreased from(18.47±4.18)°to(5.84±1.69)°after operation(P<0.05).At the last follow-up,the average VAS scores were(1.26±0.44)points,and the average loss rate of injured vertebrae was(7.26±1.74)%,and the average Cobb′s angles of kyphosis were(7.53±1.98)°,with significant differences compared with those before operation.Conclusion Minimally invasive approach single-segmental pedicle screw implantation has a satisfactory clinical effect on treatment of thoracolumbar fractures.It has the advantages of small trauma,less bleeding and short hospitalization time.