经皮内固定治疗单纯屈曲-牵张型胸腰椎骨折

Percutaneous pedicle screw fixation for simple flexion-distraction thoracolumbar fractures

[目的]探讨非植骨融合单纯经皮短节段椎弓根螺钉固定治疗伴有后方韧带复合体损伤的屈曲-牵张型(AO分类B型)不稳定胸腰段脊柱骨折的临床疗效。[方法]回顾性分析2015年1月~2018年10月本院采用非植骨融合单纯经皮短节段椎弓根螺钉固定治疗的39例伴后方韧带复合体损伤的屈曲-牵张型不稳定胸腰椎骨折患者,总结围手术期、随访和影像资料。[结果]所有患者手术顺利完成,术中未发生脊髓神经根、血管损伤;手术时间(85.52±6.10)min,术中出血量(60.34±23.12)ml,支具保护下地行走时间(2.61±0.35)d,住院天数(9.47±1.61)d。所有患者随访(14.22±1.16)个月,随时间推移,39例患者的VAS和ODI评分均显著减少(P<0.05)。影像方面,与术前相比,术后39例患者椎体前缘高度显著增加(P<0.05),而矢状面Cobb角显著减少(P<0.05)。术后椎体前缘高度和矢状面Cobb角无显著改变(P>0.05)。至末次随访时,未出现内固定断裂或松动。[结论]非植骨融合单纯经皮微创后路短节段椎弓根螺钉固定治疗无神经功能损害的伴有后方韧带复合体损伤的屈曲-牵张型不稳定胸腰段脊柱骨折安全有效。

[Objective]To explore the clinical outcomes of percutaneous short-segment pedicle screw fixation without fusion for simple flexion-distraction unstable thoracolumbar fractures accompanied with posterior ligament complex injury(AO type B).[Methods]A retrospective study was conducted on 39 patients who underwent percutaneous short-segment pedicle screw fixation without fusion for simple flexion-distraction unstable thoracolumbar fractures accompanied with posterior ligament complex injury without neurological deficiency in our hospital from January 2015 to October 2018.The perioperative,follow-up and radiographic data were summarized.[Results]All the 39 patients had operation performed successfully without iatrogenic injuries to spinal cord,nerve root and blood vessels,whereas with operation time of(85.52±6.10)min,intraoperative blood loss of(60.34±23.12)ml,time to return ambulation with brace protection of(2.61±0.35)days and hospital stay of(9.47±1.61)days.As time went in follow-up period lasted for(14.22±1.16)months,both the VAS and ODI scores significantly decreased(P<0.05).With regard to radiographic evaluation,the anterior vertebral height significantly increased,whereas the sagittal Cobb’s angle significantly decreased after operation compared with those before operation(P<0.05),however,which remained unchanged compared among time points after operation(P>0.05).To the latest follow up,no loosening or breaking of implants was noticed in anyone of the patients.[Conclusion]The percutaneous short-segment pedicle screw fixation without fusion is effective and safe treatment for simple flexion-distraction unstable thoracolumbar fractures accompanied with posterior ligament complex injury without neurological deficiency.