经皮椎弓根螺钉固定同时经伤椎置钉治疗胸腰椎骨折  

Percutaneous pedicle screw fixation for the treatment of thoracolumbar fracture

作　　者：朱卉敏[1] 张锴[1] 王衡[1] 郭新军[1] 单朝[1] 刘杰[1] 

机构地区：[1]武警河南总队医院脊柱外科,郑州450052

出　　处：《中华解剖与临床杂志》2015年第6期515-518,共4页Chinese Journal of Anatomy and Clinics

摘　　要：目的：探讨经皮椎弓根螺钉固定同时经伤椎置钉治疗胸腰椎骨折的近期疗效。方法回顾性分析2010年12月—2014年2月，武警河南总队医院脊柱外科治疗的55例无神经损伤单节段胸腰椎骨折患者的临床资料。均给予附加伤椎固定的三椎体六钉固定，其中开放组31例采用传统开放椎弓根螺钉内固定手术，微创组24例采用 Sextant 系统下微创经皮椎弓根螺钉内固定手术。对2组围手术期相关指标、后凸畸形矫正情况、腰背痛改善等进行比较。结果所有患者均获得随访，平均随访时间29个月（10~44个月）。微创组与开放组相比，手术切口总长度、术中出血量、术后引流量、术后疼痛视觉模拟评分法评分、住院时间以及术后并发症等方面差异均有统计学意义（P 值均〈0.05），但2组手术时间差异无统计学意义（P 〉0.05）。与组内术前比较，术后伤椎后凸角、Cobb 角明显降低，椎体前缘高度、矢状面指数明显增加，差异均有统计学意义（P 值均〈0.05）。术后开放组矢状面指数明显大于微创组，差异有统计学意义（P 〈0.05），而 Cobb 角、伤椎后凸角、伤椎前缘高度差异均无统计学意义（P 值均〉0.05）。结论附加伤椎经皮椎弓根螺钉固定与开放手术在对伤椎畸形的矫正方面无差异，是治疗无神经障碍胸腰椎骨折的有效方法。Objective To compare the midterm clinical results between traditional open pedicle screw fixation and minimally invasive percutaneous in the treatment of thoracolumbar fracture. Methods From December 2010 to February 2014, 55 thoracolumbar fracture patients without neurological symptoms in Department of Spine Surgery of Henan People′s Armed Police Corps Hospital were enrolled in the research. Twenty-four patients were treated with minimally invasive percutaneous pedicle screw fixation and 31 patients were treated with the traditional open pedicle screw fixation. The peri-operative index, pre-and postoperative radiography, relief of the low back pain and general health status of each group were documented and compared, respectively. Results All patients had been followed up for 10 to 44 months, 29 months on the average. There were significant differences in the incision size, surgical blood loss, surgical draining loss, visual analogue scale of back pain, length of stay and complications （all P values 〈 0. 05）, however, no difference in the surgical time was found（P 〉 0. 05）. The vertebral kyphotic angle, Cobb angle, anterior height of the fracture vertebral body and sagittal index were all significantly different between pre-operation and post-operation in each group （ all P values 〈 0. 05 ）. The sagittal index in the open group was significantly higher than that in the minimally invasive group, and the difference was statistically significant （P 〈 0. 05）. However, the Cobb angle, vertebral kyphotic angle and the anterior height of the injured vertebral body showed no significant difference （all P values 〉 0. 05）. Conclusions Minimally invasive percutaneous pedicle screw fixation through the pedicle of the fractured vertebra is a minimally-invasive and effective choice for the treatment of thoracolumbar fracture of patients without neurologic signs and symptoms, which can provide comparable result of the traditional open operation.

关 键 词：脊柱骨折 胸椎 腰椎 骨折固定术 内 经皮椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]