经伤椎植骨置钉间接减压治疗高椎管占位率的胸腰椎骨折

Treatment of thoracolumbar fractures with high spinal canal occupation by indirect decompression with bone grafting and screw placement trans-injured vertebra

目的探讨经伤椎植骨置钉间接减压治疗高椎管占位率的胸腰椎骨折的疗效。方法2017年1月—2019年10月,收治椎管占位率超过40%的胸腰椎爆裂性骨折患者70例,随机分为2组,每组35例。A组采用经伤椎植骨置钉间接减压治疗,B组采用跨节段置钉直接减压治疗。比较2组手术时间、术中出血量、术后引流量,并记录围手术期并发症发生情况。比较2组术前、末次随访时脊髓神经功能Frankel分级、矢状面Cobb角、椎管占位率,记录骨性融合及内固定物断裂情况。结果所有手术顺利完成,所有患者随访超过1年。A组手术时间短于B组,术中出血量及术后引流量少于B组,差异均有统计学意义(P<0.05)。所有患者均未发生切口感染,A组未发生脑脊液漏,B组有4例发生脑脊液漏。末次随访时,2组脊髓神经功能Frankel分级、椎管占位率、矢状面Cobb角与术前相比均有不同程度改善,差异有统计学意义(P<0.05);末次随访时,A组矢状面Cobb角优于B组,差异有统计学意义(P<0.05);2组脊髓神经功能Frankel分级、椎管占位率比较,差异无统计学意义(P>0.05)。末次随访时所有患者伤椎均获得骨性愈合,无内固定物断裂。结论经伤椎植骨置钉间接减压治疗高椎管占位率的胸腰椎骨折中短期疗效确切、安全性好,值得推广。

Objective To investigate the effect of indirect decompression with bone grafting and screw placement trans-injured vertebra in the treatment of thoracolumbar fractures with high spinal canal occupation.Methods From January 2017 to October 2019,70 cases of thoracolumbar burst fractures with spinal canal occupying rate more than 40%were randomly divided into 2 groups(n=35).In group A,indirect decompression with bone grafting and screw placement trans-injured vertebra were performed;while in group B,direct decompression with cross-injured vertebra screw placement were performed.The operation time,intraoperative blood loss and postoperative drainage volume were compared between the 2 groups.The incidence of perioperative complications was recorded.The Frankel classification of spinal cord neurological function,sagittal Cobb angle and spinal canal occupying rate before operation and at the final follow up were compared between the 2 groups.Bone fusion and internal fixation rupture were recorded.Results All the operations were successfully completed.All the patients were followed up for more than 1 year.Compared with group B,the operation time,intraopative blood loss and postoperative drainage volume of group A were decreased,all with a significant difference(P<0.05).No incision infection occurred,and no cerebrospinal fluid leakage was found in group A and 4 cases in group B.At the final follow-up,the Frankel classification of spinal cord neurological function,sagittal Cobb angle and spinal canal occupying rate were improved in different degrees in the 2 groups,all with a significant difference(P<0.05);the sagittal Cobb angle in group A was better than that in group B,and the difference was statistically significant(P<0.05);there was no significant difference in Frankel classification of spinal cord neurological function and spinal canal occupying rate between the 2 groups(P>0.05).All the injured vertebrae achieved bony fusion without internal fixation rupture.Conclusion Indirect decompression with bone grafting and screw placement trans-injured vertebra in the treatment of thoracolumbar fractures with high spinal canal occupation is effective and safe,thus being worthy of popularization.