后路间接减压术中应用CT评价在胸腰椎爆裂骨折伴不完全神经损伤治疗中作用

Effect of posterior indirect decompression plus intraoperative CT scan on thoracolumbar burst fractures with incomplete nerve injury

目的 观察后路间接减压术联合术中CT评价治疗胸腰椎爆裂骨折伴不完全神经损伤的临床疗效,探讨术中应用CT评价的作用。方法 2021年5月-2022年5月河南省人民医院诊治胸腰椎爆裂骨折伴不完全神经损伤患者48例,均行后路间接减压复位椎弓根螺钉内固定术,术中行CT检查,对骨折复位情况进行评估。随访至2023年12月,术前、术后即刻、术后3个月及末次随访时通过X线、CT等影像学检查测定伤椎矢状位Cobb’s角、椎体前缘高度压缩比、椎管正中矢状径;术前、末次随访时采用Frankel分级评估患者神经功能;记录术后骨折愈合情况及并发症发生情况。结果 患者术后即刻、术后3个月时、末次随访时伤椎矢状位Cobb’s角[(5.68±2.65)°、(5.33±2.44)°、(5.31±2.36)°]均小于术前[(25.12±4.08)°](P<0.05),椎体前缘高度压缩比[(95.06±3.86)%、(93.81±3.33)%、(90.21±2.95)%]、椎管正中矢状径[(92.46±4.09)%、(91.54±3.71)%、(90.81±3.60)%]均高于术前[(38.90±5.66)%、(38.13±3.59)%](P<0.05);术后即刻、术后3个月时、末次随访时上述指标比较差异均无统计学意义(P>0.05)。末次随访时,23例Frankel分级C级患者恢复至D级10例,恢复至E级10例,无变化3例;25例Frankel分级D级患者恢复至E级21例,无变化4例;末次随访时Frankel分级E级比率(64.6%)高于术前(0)(χ^(2)=42.878,P<0.001)。48例患者术后均骨性愈合,未出现感染、迟发性神经功能损害、内固定松动或断裂、后凸畸形等并发症,无需二次手术减压;骨折愈合后取出内固定。结论 胸腰椎爆裂骨折伴不完全神经损伤患者行后路间接减压复位椎弓根螺钉内固定术中应用CT辅助评价可即时了解椎管内骨块复位情况,提高复位准确率,有效改善伤椎高度及后凸畸形,促进神经功能恢复,术后并发症少。

Objective To observe the clinical effect of posterior indirect decompression combined with intraoperative CT evaluation on thoracolumbar burst fractures with incomplete nerve injury,and to explore the role of intraoperative CT evaluation.Methods From May 2021 to May 2022,48 patients with thoracolumbar burst fractures with incomplete nerve injury underwent posterior indirect decompression and pedicle screw internal fixation in Henan Provincial People's Hospital.Intraoperative CT examination was performed to evaluate the fracture reduction.The patients were followed up till December 2023.Before,immediately after and 3 months after operation and at the latest follow-up,X-ray and CT were used to measure the Cobb's angle in sagittal position of injured vertebra,anterior margin height compression ratio and median sagittal diameter of the spinal canal.The nerve function was evaluated by Frankel grading before operation and at the latest follow-up.Fracture healing and complications were recorded.Results Immediately after operation,3 months after operation and at the latest follow-up,the Cobb's angle in sagittal position of injured vertebra[(5.68±2.65)°,(5.33±2.44)°,(5.31±2.36)°]was smaller than that before operation[(25.12±4.08)°](P<0.05),the anterior margin height compression ratio[(95.06±3.86)%,(93.81±3.33)%,(90.21±2.95)%]and median sagittal diameter[(92.46±4.09)%,(91.54±3.71)%,(90.81±3.60)%]were higher than those before operation[(38.90±5.66)%,(38.13±3.59)%](P<0.05),and there were no significant differences in the above indexes immediately after operation,3 months after operation and at the latest follow-up(P>0.05).At the latest follow-up,in 23 patients with Frankel grade C,10 patients returned to grade D,10 to grade E,and 3 had no change;in 25 patients with grade D,21 returned to grade E and 4 showed no change.The rate of Frankel grade E was higher at the latest follow-up(64.6%)than that before operation(0)(χ^(2)=42.878,P<0.001).Bone healing was achieved in all patients after operation,and no complications such as infection,delayed nerve function injury,loosening or rupture of internal fixation,or kyphosis occurred.No secondary decompression was required.Internal fixation was removed after fracture healing.Conclusion CT evaluation in posterior indirect decompression can reveal the reduction of bone mass in the spinal canal in time,improve the reduction accuracy,effectively improve the height of the injured vertebra and kyphosis,promote the recovery of nerve function,and reduce postoperative complications of patients with thoracolumbar burst fractures with incomplete nerve injury.