经皮内固定结合单侧椎板开窗减压治疗A3型胸腰椎骨折21例

Percutaneous posterior fixation combined with unilateral fenestration decompression for treatment of type A3 thoracolumbar fractures

目的探讨采用微创通道下经皮椎弓根钉内固定结合单侧椎板开窗减压治疗A3型胸腰椎骨折的临床疗效。方法自2015年9月至2018年8月连云港市第一人民医院收治的43例A3型胸腰椎骨折病人,随机数字表法分成A,B两组,A组21例行经皮椎弓根钉棒系统内固定技术结合单侧开窗减压治疗;B组22例行切开复位椎弓根内固定结合椎板开窗减压治疗,从围手术期参数、影像学指标、神经功能恢复情况等方面进行对比研究。结果随访时间为618个月,平均9.8个月。A组手术时间、术中出血量、伤口引流量、术后3 d及末次随访视觉模拟评分法(VAS)评分分别为(114.29±14.52)min、(38.57±8.68)mL、(50.47±55.34)mL、(2.86±0.96)分、(1.14±0.79)分,B组分别为(123.41±12.38)min、(267.95±26.76)mL、(217.50±27.68)mL、(3.59±1.14)分、(1.86±0.94)分,差异有统计学意义(P<0.05)。两组伤椎后凸Cobb角,椎管狭窄率(rate of spinal compromise,RSC)及神经功能均较术前明显改善(P<0.05)。A组术前、术后1周、术后6个月后凸Cobb角分别为(16.20±4.25)°、(4.89±1.22)°、(4.95±1.17)°,B组分别为(15.11±5.61)°、(4.56±0.93)°、(4.64±0.87)°,两组间比较差异无统计学意义(P>0.05)。A组术前、术后1周、术后6个月椎管狭窄率(RSC)分别为(31.23±8.21)%、(4.54±1.34)%、(4.30±1.33)%,B组分别为(29.25±9.66)%、(4.93±1.56)%、(4.71±1.48)%,两组间比较差异无统计学意义(P>0.05)。所有手术切口均一期愈合。A组术中1例发生脑脊液漏。结论经皮椎弓根钉棒系统内固定技术结合单侧椎板开窗减压治疗A3型胸腰椎骨折是一种安全有效的微创技术。

Objective To investigate the clinical effect of minimally invasive percutaneous posterior fixation combined with unilateral fenestration decompression for the treatment of A3 thoracolumbar fractures.Methods lumbar fractures in The First People’s Hospital of Lianyungang from September 2015 to August 2018 were randomlyassigned into Group A and Group B.21 cases in Group A received percutaneous pedicle screw system internal fixation technique combined with unilateral fenestration decompression,while 22 patients in Group B were treated with open reduction pedicle fixation combined with fenestration decompression.The perioperative parameters,imaging indexes and neurological function recovery were compared between two groups.Results postoperative drainage volume and VAS score(at 3 rd day and the last follow-up after operation)of Group A were(114.29±14.52)min,(38.57±8.68)ml,(50.47±55.34)ml,(2.86±0.96),(1.14±0.79),respectively.The bleeding loss,operation time,postoperative drainage volume and VAS score(at 3 rd day and the last follow-up after operation)of Group B were(123.41±12.38)min,(267.95±26.76)ml,(217.50±27.68)ml,(3.59±1.14),(1.86±0.94),respectively.There was a significant difference between the two groups(P<0.05).Cobb angle,rate of spinal compromise,and neural function were obviously improved compared with that of preoperative(P<0.05).In group A,the Cobb angle was(16.20±4.25)°,(4.89±1.22)°and(4.95±1.17)°before operation,at 7 days and 6 months after operation,respectively.In group B,the Cobb angle was(15.11±5.61)°(4.56±0.93)°and(4.64±0.87)°before operation,at 7 days and 6 months after operation,respectively.No significant difference in Cobb angle was found between the two groups(P>0.05).In group A,the rate of spinal compromise was(31.23±8.21)%,(4.54±1.34)%,(4.30±1.33)%before operation,at 7 days and 6 months after operation,respectively.In group B,the rate of spinal compromise was(29.25±9.66)%,(4.93±1.56)%and(4.71±1.48)%before operation,at 7 days and 6 months after operation,respectively.No significant difference in rate of spinal compromise was found between the two groups(P>0.05).All incisions healed in one stage.Cerebrospinal fluid leakage occurred in 1 case during the operation of Group A.Conclusion Percutaneous pedicle screw system internal fixation technique combined with unilateral vertebral lamina fenestration and decompression is a safe,effective and minimally invasive technique for the treatment of type A3 thoracolumbar fractures.