胸腰段脊柱骨折内固定:经伤椎与跨伤椎短节段经皮椎弓根螺钉内固定系统的应用

Short-segment percutaneous pedicle screw instrumentation for the treatment of thoracolumbar fractures: bilateral fracture level and cross-fracture level

背景:目前临床上对后路短节段经皮椎弓根螺钉治疗胸腰段骨折的随访数据有限,且是否应进行伤椎置钉尚存在一定的争议。目的:探究短节段经皮椎弓根螺钉内固定系统经伤椎置钉与跨伤椎固定修复胸腰段骨折的短期疗效。方法:纳入使用经皮椎弓根螺钉内固定的胸腰段骨折患者27例,随机将患者分为经伤椎置钉组和跨伤椎固定组。所有治疗均已取得患者知情同意,且得到医院伦理委员会批准。使用目测类比评分、Oswestry功能障碍指数评估临床症状的改善情况,使用骨折椎体前缘相对高度,矢状面后凸Cobb角度评估骨折椎体复位情况。结果与结论:①所有纳入随访的患者均顺利完成手术,经伤椎置钉组随访8-20个月,跨伤椎置钉组随访5-17个月,均未出现内固定断裂、伤椎高度丢失等并发症;②2组患者术后的目测类比评分及Oswestry功能障碍指数均较术前明显好转(P < 0.05),组间对比差异无显著性意义(P > 0.05);③2 组患者术后骨折椎体前缘相对高度及矢状面后凸Cobb角均较术前好转,差异有显著性意义(P < 0.05),组间对比差异无显著性意义(P > 0.05);④提示随访期间使用短节段经皮椎弓根螺钉内固定系统修复胸腰段骨折能够取得满意疗效,而经伤椎置钉和跨节段固定并未表现出明显差异。

BACKGROUND: At present, the clinical follow-up data of posterior short-segment percutaneous pedicle screw for thoracolumbar fractures are limited, and there is still some controversy about whether the injured vertebra should be placed with screw. OBJECTIVE: To investigate the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation for the treatment of thoracolumbar fractures. METHODS: Totally 27 patients, who suffered from thoracolumbar fractures and underwent short-segment percutaneous pedicle screw instrumentation, were retrospectively analyzed. These patients were divided into two groups: bilateral fracture level screw group and cross-fracture level instrumentation group. Informed consent was obtained from all patients. This study was approved by the Hospital Ethics Committee. Visual analogue scale score and Oswestry disability index were used to access clinical outcomes. Relative fracture-level vertebral body height and Cobb angle were used to access the reduction situation of fractured vertebrae. RESULTS AND CONCLUSION:(1) All surgeries were completed successfully. Patients in the bilateral fracture level screw group were followed up for 8-20 months. Patients in the cross-fracture level instrumentation group were followed up for 5-17 months. No complications such as internal fixation fracture or reduction loss were observed.(2) Visual analogue scale score and Oswestry disability index were significantly improved after operation in both groups (P < 0.05). No significant difference was found between the two groups (P > 0.05).(3) Relative fracture-level vertebral body height and Cobb angle were improved after operation when compared to pre-operative data of both groups (P < 0.05). The difference between groups presented no statistically difference (P > 0.05).(4) During short-term follow-up, the short-term effectiveness of short-segment percutaneous pedicle screw instrumentation is proven to have satisfactory effect;no significant difference was observed between bilateral fracture level screw and cross-fracture level instrumentation.