椎弓根螺钉撑开复位治疗胸腰椎爆裂性骨折伴不完全神经损伤

Posterior indirect reduction and pedicle screw fixation without laminectomy for thoracolumbar burst fractures with incomplete neurologic deficit

目的 :探讨无椎板切除减压的情况下,单纯后路椎弓根螺钉撑开复位治疗胸腰椎爆裂性骨折伴不完全神经损伤的疗效。损伤的疗效。方法 :方法回顾性分析我院2010年3月至2014年5月资料较完整的胸腰椎爆裂骨折合并不完全神经损伤患者36例,包括27例男性患者和9例女性患者,平均年龄35.2岁(20~56岁)。所有病例皆是单节段骨折,具体是3例T11,6例T12,19例L1,8例L2。所有患者皆行单纯后路椎弓根螺钉固定,未行椎板切除减压。根据患者术前术后的临床和影像学资料,进行疗效分析。结果 :所有患者皆获得随访,术后平均随访时间32.8±11.6月。所有患者术后均出现至少1级以上的Frankel分级改善。ASIA评分从术前的25.4±10.8提高至术后42.1±10.5。术前后凸角为25.9°±3.4°,术后后凸角为6.9°±2.2°,两者之间有统计学差异。末次随访时后凸角为7.9°±2.0°较术前有显著差异,较术后无统计学差异。椎管矢状径从术前的5.5±1.3mm提高至术后11.1±2.2mm,有统计学差异(P<0.05)。术前的椎管狭窄指数为32.9%±7.8%,术后的椎管狭窄指数为84.8%±7.3%,差异有统计学意义。随访过程中未发现断钉和内固定失败等问题。结论 :单纯后路椎弓根螺钉撑开复位可用于治疗胸腰椎爆裂性骨折伴不完全神经损伤患者,并获得很好的疗效,因未行椎板切除减压,该治疗方案具有手术时间短、创伤小的优点。

Objective Objective To evaluate the efficacy of posterior indirect reduction and pedicle screw fixation without laminectomy for the treatment of thoracolumbar burst fractures withincomplete neurologic deficit. y for the treatment of thoracolumbar burst fractures withincomplete neurologic deficit. Methods Methods Between March 2008 and May 2012, 36 patients(9 women and 27 men) met the criteria for inclusion in the study, which included age from 20 to 56 years. Single-level thoracolumbar(T11–L2) burst fracture was confirmed with plain radiographs and computed tomography, including three T11, six T12, nineteen L1 and eight L2. Incomplete neurologic deficits were confirmed with full neurologic examination at the time of admission. All patients underwent posterior indirect reduction and pedicle screw fixation without laminectomy. Clinical and radiologic outcomes were assessed preoperatively and postoperatively.n without laminectomy. Clinical and radiologic outcomes were assessed preoperatively and postoperatively.Results Results All patients exhibited neurologic improvement for at least one Frankel grade. The mean ASIA motor score had improved in all thirty-six patients(from 25.4 ± 10.8 to 42.1 ± 10.5) with an increase in the recovery rate of the ASIA score. The local kyphosis angle was reduced from 25.9°±3.4° to 6.9°±2.2°(P<0.05) and remained 7.9°±2.0°(P>0.05) at the latest follow-up. The mean vertebral canal diameter increased from 5.5±1.3 mm preoperation to 11.1±2.2 mm postoperation(P<0.05). The mean canal stenosis index was 32.9%±7.8% and 84.8%±7.3% before and after the operation, respectively(P<0.05). No serious complications or fixation failures were observed during follow-up.s or fixation failures were observed during follow-up.Conclusion Conclusion Thoracolumbar burst fractures with incomplete neurologic deficit can be effectively treated by posterior indirect reduction and pedicle screw fixation without laminectomy.