伴有椎管占位的单节段胸腰椎爆裂骨折手术策略

Surgical strategy for single-level thoracolumbar burst fractures with spinal canal involved

[目的]通过观察伴有不同程度椎管占位的单节段胸腰椎爆裂骨折患者采用三种手术方案的临床疗效,探讨此类骨折个体化治疗策略.[方法]对2016年4月~2018年1月伴有不同程度椎管占位的胸腰椎爆裂骨折42例患者进行回顾性分析,根据术前椎管占位程度分为三组,15例椎管占位<30%者行后路伤椎单侧置钉短节段内固定术,14例占位30%~50%者行后路伤椎单侧置钉短节段内固定+经椎弓根打压植骨术,13例占位>50%行后路伤椎者单侧置钉短节段内固定+经椎弓根打压植骨术+全椎板减压术.[结果]30%~50%组和>50%组手术时间显著长于<30%组(P<0.05);>50%组出血量显著高于<30%组和30%~50%组(P<0.05);三组间术口长度比较差异均无统计学意义(P>0.05).所有患者术后随访(14.46±2.25)个月.三组患者均随术后时间推移腰背痛VAS评分显著减少(P<0.05),相同时间点三组间VAS评分差异无统计学意义(P>0.05).术后三组的伤椎前缘高度比、Cobb角及椎管占位率均较术前显著改善(P<0.05);但三组间相应时间点上述影像测量指标的差异均无统计学意义(P>0.05);三组随访期间无内固定松动、断裂等发生.[结论]伴有椎管占位的单节段胸腰椎爆裂骨折采用个体化手术方案可有效恢复并维持伤椎高度、Cobb角,解除椎管占位.

[Objective] To explore the individualized surgical strategy by comparing the clinical outcomes of three surgical procedures for single-level thoracolumbar burst fractures with different degrees of spinal canal compromised. [Methods] A retrospective study was performed on 42 patients who received operation for single-level thoracolumbar burst fractures with different degrees of spinal canal involved from April 2016 to January 2018. Based on the extent of preoperative spinal canal involved,the patients were divided into three groups. Of them, 15 patients who had less than 30% spinal canal occupied received unilateral pedicle screw fixation for the fractured vertebra, 14 patients who had 30%-50% canal occupied underwent unilateral pedicle screw fixation combined with transpedicular interbody bone grafting, and 13 patients who had more than 50% canal occupied received unilateral pedicle screw fixation combined with transpedicular interbody bone grafting and total laminectomy. [Results]The 30%~50% group and >50% group proved significantly longer operation time than the <30% group(P<0.05), while the >50% group had significantly more blood loss than the 30%~50% group and the <30% group(P<0.05). However, no statistically differences in incision length were noticed among the three groups(P>0.05). All patients were followed up for 12 to 18 months with a mean of(14.46±2.25) months. The VAS score significantly decreased as time went on in the three group(P<0.05), although no statistically significant differences in VAS score were proved among the three groups at any matched time point(P>0.05). In terms of radiographically measurements, the anterior height ratio, Cobb angle and canal occupied ratio significantly improved postoperatively in the three groups compared with those before operation(P<0.05), despite of the facts that no statistically significant differences in aforesaid parameters were found among the three groups at any corresponding time point(P>0.05). No internal fixation loosening or breaking happened in any patient of the three groups. [Conclusion]The individualized surgical procedures for single-level thoracolumbar burst fractures with spinal canal involved do effectively restore and maintain the height and Cobb angle of the injured vertebral body and relieve the spinal canal occupied.