后路有限切开减压植骨联合经皮椎弓根螺钉内固定治疗胸腰椎C型骨折的疗效

Efficacy of limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation in the treatment of type C thoracolumbar fractures

目的:比较后路有限切开减压植骨联合经皮椎弓根螺钉与传统后路切开减压植骨联合椎弓根螺钉内固定治疗胸腰椎C型骨折的疗效。方法:采用回顾性队列研究分析2015年1月至2019年12月新疆医科大学附属中医医院收治的60例胸腰椎C型骨折患者的临床资料,其中男37例,女23例;年龄25~61岁[(46.5±9.8)岁]。损伤节段:T 10~11 11例,T 11~12 12例,T 12~L 1 19例,L 1~2 9例,L 2~3 9例。美国脊髓损伤协会(ASIA)分级:A级27例,B级21例,C级12例。30例行后路有限切开减压植骨联合经皮椎弓根螺钉内固定(微创手术组),30例行传统后路切开减压植骨联合椎弓根螺钉固定(传统切开组)。比较两组手术时间、术中出血量;术前,术后1周、6个月及末次随访时矢状面Cobb角、伤椎前缘高度、视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);末次随访时ASIA分级;术中及术后并发症发生率。 结果:患者均获随访35~46个月[(39.0±3.4)个月]。微创手术组手术时间为150(120,210)min,术中出血量为145(100,200)ml,短于或少于传统切开组的210(210,240)min、330(300,350)ml( P<0.01)。术前,术后1周、6个月及末次随访时两组矢状面Cobb角、伤椎前缘高度、ODI差异均无统计学意义( P>0.05)。术后1周、6个月微创手术组VAS分别为3.0(2.0,4.0)分、1.0(1.0,2.0)分,低于传统切开组的4.0(4.0,5.0)分、2.0(1.0,2.0)分( P<0.01)。术前及末次随访时两组VAS、末次随访时两组ASIA分级差异均无统计学意义( P>0.05)。术中及术后微创手术组并发症发生率为10.0%(3/30),低于传统切开组的33.3%(10/30)( P<0.05)。 结论:与传统后路切开减压植骨联合椎弓根螺钉相比,后路有限切开减压植骨联合经皮椎弓根螺钉内固定治疗胸腰椎C型骨折具有手术时间短、术中出血量少、术后早期疼痛缓解明显和并发症发生率低等优势。

Objective To compare the efficacy of limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation and conventional posterior laminotomy decompression and bone grafting combined with pedicle screw internal fixation in the treatment of type C thoracolumbar fractures.Methods A retrospective cohort study was conducted to analyze the clinical data of 60 patients with type C thoracolumbar fractures who were admitted to Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from January 2015 to December 2019,including 37 males and 23 females,aged 25-61 years[(46.5±9.8)years].Injured segments included To-1 in 11 patients,Ti-2 in 12,T,2-L,in 19,L.in 9,and L2.3 in 9.American Spinal Injury Association(ASIA)impairment scale was grade A in 27 patients,grade B in 21,and grade C in 12.Thirty patients underwent limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation(minimally invasive surgery group),and the other 30 patients underwent conventional posterior laminotomy decompression and bone grafting combined with pedicle screw internal fixation(conventional laminotomy group).The operation time and intraoperative blood loss were compared between the two groups.The sagittal Cobb angle,anterior edge height of the fractured vertebra,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)before,at 1 week,6 months after surgery and at the last follow-up,the ASIA grading at the last follow-up,and the incidence of intraoperative and postoperative complications were compared between the two groups.Results All the patients were followed up for 35-46 months(39.0±3.4)monthsj.In the minimally invasive surgery group,the operation time and the intraoperative blood loss were 150(120,210)minutes and 145(100,200)ml respectively,which were shorter or less than 210(210,240)minutes and 330(300,350)ml in the conventional laminotomy group(P<0.01).There were no significant differences in the sagittal Cobb angle,anterior edge height of the fractured vertebra or ODI between the two groups before,at 1 week and 6 months after surgery and at the last follow-up(P>0.05).The VAS scores of the minimally invasive surgery group were 3.0(2.0,4.0)points and 1.0(1.0,2.0)points at 1 week and 6 months after surgery,which were lower than those of the conventional laminotomy group[4.0(4.0,5.0)points and 2.0(1.0,2.O)points](P<0.01).There were no significant differences in VAS or ASIA grading between the two groups before surgery and at the last follow-up(P>0.05).The incidence of intraoperative and postoperative complications in the minimally invasive surgery group was 10.0%(3/30),which was lower than that in conventional laminotomy group[33.3%(10/30)](P<0.05).Conclusion For type C thoracolumbar fractures,compared with conventional posterior laminotomy decompression and bone grafting combined with pedicle screw internal fixation,limited posterior laminotomy decompression and bone grafting combined with percutaneous pedicle screw internal fixation has the advantages of shorter operation time,less intraoperative blood loss,more obvious early postoperative pain relief and a lower complication rate.