经皮椎弓根钉内固定术治疗胸腰椎爆裂性骨折的疗效评估

Efficacy Assessment in the Treatment of Thoracolumbar BurstFractures by Percutaneous Pedicle Screw Fixation

目的:评估经皮椎弓根钉内固定术治疗胸腰椎爆裂性骨折的临床疗效。方法:对2018年8月至2020年1月手术治疗的30例胸腰椎爆裂性骨折的患者进行回顾性分析。根据术前骨折块椎管侵占率不同,分为低侵占率组(<50%)和高侵占率组(≥50%),各组分别通过经皮椎弓根钉内固定进行手术治疗。术后进行临床随访观察,比较各组术前术后影像学指标(伤椎前缘高度比、后凸Cobb角、骨折块的椎管侵占率)、术后功能恢复情况(VAS评分、ODI评分)及并发症发生情况。结果:全部病例均未出现神经功能损伤、感染、螺钉松动或断裂。低侵占率组中,术后3 d、术后1 a与术前影像学指标比较均有明显恢复,差异有统计学意义(P<0.05);术后1 a椎体前缘高度比、Cobb角与术后3 d比较,差异无统计学意义(P>0.05);术后1 a骨折块的椎管侵占率与术后3 d比较有减小,差异有统计学意义(P<0.05)。高侵占率组中,术后3 d、术后1 a与术前影像学指标比较均有明显恢复,差异有统计学意义(P<0.05);术后1 a椎体前缘高度比、Cobb角与术后3 d比较有部分丢失,差异有统计学意义(P<0.05);术后1 a骨折块的椎管侵占率与术后3 d比较有减小,差异有统计学意义(P<0.05)。低侵占率组和高侵占率组中,术后1 a VAS评分、ODI评分与术前比较均明显改善,差异有统计学意义(P<0.05)。结论:经皮椎弓根钉内固定术治疗胸腰椎爆裂性骨折能够取得满意的临床疗效,在严格把握手术适应证的前提下,可以作为无神经症状的胸腰椎爆裂性骨折的主要治疗方法。

Objective:To evaluate the clinical efficacy of percutaneous pedicle screw fixation in the treatment of thoracolumbar burst fractures.Methods: A retrospective analysis of 30 patients with thoracolumbar burst fractures who were surgically treated from August 2018 to January 2020 was carried out.They were divided into two groups according to different spinal canal encroachment ratios: low encroachment(ratio<50%) and high encroachment group(ratio≥50%).Percutaneous pedicle screw fixation was performed in each group.Postoperative clinical follow-up observations were performed to compare preoperative and postoperative imaging indicators(anterior vertebral height ratio, Cobb angle, spinal canal encroachment ratio), postoperative function recovery(visual analogue scale scores, Oswestry disability index) and complications.Results: No neurological impairment, infection or pedicle screw breakage and loosening occurred in all cases.In low encroachment group, the imaging indicators significantly recovered 3 d after operation and 1 year after operation as compared with those before operation(P<0.05).There was no significant difference in anterior vertebral height ratio and Cobb angle between 1 year after operation and 3 d after operation(P>0.05).Spinal canal encroachment ratio in 1 year after operation was decreased compared with 3 d after operation(P<0.05).In high encroachment group, the imaging indicators significantly recovered 3 d after operation and 1 year after operation as compared with those before operation(P<0.05).The anterior vertebral height ratio and Cobb angle of 1 year after operation were partially lost than those of 3 d after operation(P<0.05).Spinal canal encroachment ratio in 1 year after operation was decreased compared with 3 d after operation(P<0.05).The VAS scores and ODI were significantly lower 1 year after operation than those before operation in both groups(P<0.05).Conclusion: Percutaneous pedicle screw fixation can obtain satisfactory clinical efficacy in the treatment of thoracolumbar burst fractures.It could be promoted as the ideal treatment for thoracolumbar burst fractures without neurological deficit under strict control of surgical indications.