伴神经功能损伤胸腰椎骨折微创通道减压经皮椎弓根钉固定

Minimally invasive decompression and percutaneous pedicle screw fixation for thoracolumbar fractures with neurologicaldeficits

[目的]探讨微创扩张通道减压联合纯A-P椎弓根内固定治疗A3型胸腰椎骨折伴神经功能损伤的临床疗效。[方法]回顾性分析2022年8月—2023年8月本院收治的16例胸腰椎骨折合并神经损伤且采用上述术式治疗患者的临床资料,评估临床及影像结果。[结果]所有患者均顺利完成手术,无严重并发症。随访时间平均(9.4±3.9)个月,与术前相比,术后3个月及末次随访时VAS评分[(7.4±0.6),(1.8±0.6),(0.7±0.7), P<0.001]、ODI评分[(81.8±8.7),(16.5±4.6),(9.4±4.1), P<0.001]、JOA评分[(6.6±1.5),(22.5±1.5),(26.8±1.3), P<0.001]及ASIA评级[例, A/B/C/D/E,(0/0/0/16/0),(0/0/0/0/16),(0/0/0/0/16), P<0.001]显著改善。影像方面,与术前相比,术后3个月及末次随访时骨折椎体前缘高度比[(61.4±12.9)%,(94.3±3.6)%,(92.1±4.0)%, P<0.001]、节段后凸角[(9.2±5.4)°,(0.9±1.5)°,(1.0±1.5)°, P<0.001]均显著改善。[结论]微创扩张通道减压联合纯A-P经皮椎弓根螺钉固定治疗胸腰椎A3型骨折伴轻微神经损伤可显著矫正畸形,改善神经功能。

[Objective]To evaluated the surgical efficacy of minimally invasive expansive decompression combined with anteroposteri-or pedicle screw fixation for type A3 thoracolumbar fractures with neurological deficits.[Methods]A retrospective analysis was conductedon 16 patients who received abovementioned surgical treatment for thoracolumbar fractures with nerve injuries between August 2022 andAugust 2023.The clinical and imaging documents were evaluated.[Results]All patients underwent the surgery successfully without any se-vere complications,and followed up for(9.4±3.9)months in mean.Compared to those preoperatively,the VAS score[(7.4±0.6),(1.8±0.6),(0.7±0.7),P<0.001]and ODI score[(81.8±8.7),(16.5±4.6),(9.4±4.1),P<0.001]significantly decreased,while JOA scores significantly in-creased[(6.6±1.5),(22.5±1.5),(26.8±1.3),P<0.001]3 months postoperatively and at the final follow-up.In term of neurological function,9patients recovered to ASIA grade E 1 week postoperatively,additionally,all the 16 patients returned to ASIA grade E at the latest followup.Regarding to imaging,the anterior vertebral height ratio(AVHR)increased significantly[(61.4±12.9)%,(94.3±3.6)%,(92.1±4.0)%,P<0.001],while local kyphotic angle(LKA)decreased significantly[(9.2±5.4)°,(0.9±1.5)°,(1.0±1.5)°,P<0.001]with time preoperatively,3months postoperatively and latest follow-up.[Conclusion]The minimally invasive expansive decompression combined with pure anteropos-terior percutaneous pedicle screw fixation is effective in correcting deformity and improving neurological function for type A3 thoracolum-bar fractures with nerve injuries.