微创经皮并结合伤椎椎弓根螺钉固定治疗胸腰椎骨折  

Percutaneous pedicle screw fixation for the treatment of thoracolumbar fracture

作　　者：钱济先[1] 纪振钢[1] 高浩然[1] 李存孝[1] 钱澍[1] 刘海潮[1] 

机构地区：[1]第四军医大学唐都骨科医院脊柱外科,西安710038

出　　处：《中国矫形外科杂志》2013年第16期1591-1596,共6页Orthopedic Journal of China

摘　　要：[目的]探讨结合伤椎椎弓根螺钉内固定的经皮微创治疗胸腰椎骨折的疗效。[方法]回顾性分析2010年4月～2012年3月30例胸腰椎骨折患者采用经皮空心椎弓根螺钉固定患者疗效,均采用结合伤椎的6钉固定。随访时间最短8周,最长22个月,平均14个月。交通事故伤19例,摔伤11例,平均年龄43岁。手术方法采用经皮椎弓根螺钉结合伤椎短螺钉固定复位术。所有患者术前均采用TLICS评分。对患者手术前后VAS评分,ODI指数,术中出血,术后住院时间,后凸畸形矫正情况等进行统计。[结果]本组病例术中出血量、术后住院时间、术前术后VAS评分、ODI指数等均有显著统计学差异(P<0.05)。术前与术后影像学比较,矢状位后凸Cobb角、伤椎自身成角、矢状指数、伤椎椎体前缘高度均有显著性改善(P<0.05)。[结论]结合伤椎内固定的微创经皮椎弓根螺钉内固定术具有出血少、住院时间短、术后并发症少等优点,对伤椎畸形的矫正和内固定的效果满意,具有与开放手术相同的疗效。[Objective] To Evaluate the efficacy of percutaneous pedicle screw fixation for the treatment of thoracolumbar fracture. [ Method] Thirty patients with thoracolumbar fracture underwent percutaneous pedicle screw fixation surgery from April 2010 to March 2012 were included in this retrospective study. The average follow-up was 14 months. In MISS group, the thoraco- lumbar fracture was caused by traffic accidents （ n = 19） and falling injury （ n = 11 ）. X-ray, CT （ computed tomography） and MRI （magnetic resonance imaging） was performed to evaluate the type of the fracture, displacement, the integrity of posterior ligament complex as well as the presence of spinal cord injury and compression. A series of indices including the blood loss, hos- pitalization duration, pre-and post-operative VAS （visual analogue scale） score, ODI （Oswestry disability index） as well as cor- rection of kyphotic deformity were evaluated and with that to determine the Thoracolumbar Injury Classification and Severity Score （TLICS）. [ Result] Significant difference was noted in terms of blood loss, hospitalization duration, post-operative VAS and complications in this group. （ P 〈 0.05 ）. For the pre-and post-operative imaging results, significant difference was noted in terms of Cobb angle （in a sagittal view） ,the local angle of fracture vertebral body,the sagittal index and the height of anterior vertebral body （ P 〈 0.05 ）. [ Conclusion] Percutaneous pedicle screw fixation is an excellent minimally-invasive therapeutic choice for patients with thoracolumbar fracture. It showed the characteristics including easy performance, satisfactory safety,less complications and blood loss. Additionally, the surgery could attenuate the hospitalization duration and promote the recovery of the patients.

关 键 词：骨折 胸腰椎 伤椎固定 微创 

分 类 号：R687.3[医药卫生—骨科学]