经椎旁肌间隙入路椎弓根螺钉固定结合硫酸钙治疗单一椎体胸腰椎骨折  

Pedicle screw fixation through Wiltse approach combined with injectable calcium sulfate bone cement for single-level thoracolumbar fracture

作　　者：占方彪[1] 王诗军[2] 程军[1] 冯世龙[1] 谢鲤钟[1] 李波[1] 张友[1] Zhan Fang-biao Wang Shi-jun Cheng Jun Feng Shi-long Xie Li-zhong Li Bo Zhang You(Department of Orthopedics, Chongqing Three Gorges Central Hospital, Chongqing 404000, China Department of Orthopedics, First Hospital, Peking University, Beijing 100034, China)

机构地区：[1]重庆三峡中心医院骨科,重庆市404000 [2]北京大学第一医院骨科,北京市100034

出　　处：《中国组织工程研究》2017年第19期2986-2992,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:胸腰椎骨折是脊柱最常见的骨折类型,传统的后正中入路对椎旁肌的广泛剥离与牵拉,椎旁肌缺血和失神经支配,导致术后腰背肌萎缩,并产生顽固性的腰背痛。而微创手术治疗越来越被广大的骨科医生所接受。目的:探讨经椎旁肌间隙椎弓根螺钉内固定结合可注射硫酸钙骨水泥治疗单一椎体胸腰椎骨折的临床疗效。方法:回顾性分析获得完整随访资料的52例单一椎体胸腰椎骨折不伴有神经损伤患者,根据手术入路分为2组。观察组28例,采用后路经椎旁肌间隙入路短节段椎弓根螺钉固定结合伤椎硫酸钙植入;对照组24例,采用传统后正中入路短节段椎弓根螺钉固定结合伤椎硫酸钙植入。比较2组患者的手术时间、手术出血量、住院时间:观察2组患者术前及术后1周、3个月时腰背部疼痛情况;观察2组患者术前、术后下地前和末次随访时X射线片上伤椎前缘高度百分比;记录2组患者手术并发症及内固定松动、断裂情况。结果与结论:(1)52例患者均获得随访,随访时间16-24个月;(2)观察组手术时间、手术出血量及住院时间均少于对照组,差异均有显著性意义(P<0.05);(3)2组术后不同时点目测类比评分均低于术前(P<0.05);2组术后不同时间点目测类比评分比较,差异均有显著性意义(P<0.05)。(4)2组患者术后下地前及末次随访时伤椎前缘高度百分比均较术前明显改善,差异均有显著性意义(P<0.05);2组间不同时点伤椎前缘高度比值比较,差异均无显著性意义(P>0.05);(5)结果提示,在严格掌握手术适应证的前提下,经椎旁肌间隙入路椎弓根螺钉固定结合硫酸钙治疗单一椎体胸腰椎骨折安全可靠,可即刻恢复伤椎前缘高度,减轻疼痛,远期疗效满意。和传统后正中入路手术相比,手术时间更短,术中出血量更少。BACKGROUND： Thoracolumbar fracture is most common seen in spinal fractures. The paraspinal muscle is subjected to extensive detachment and traction in traditional posterior approach, so the muscular ischemia and denervation lead to muscle atrophy further inducing intractable low back pain. Thereafter, minimally invasive spinal surgery becomes more and more popular.OBJECTIVE： To investigate the clinical efficacy of pedicle screw fixation through Wiltse approach combined with injectable calcium sulfate bone cement for single-level thoracolumbar fracture.METHODS： Clinical data of 52 patients with single-level thoracolumbar fracture without nerve injury were analyzed retrospectively, and were then assigned to observation （n=28） and control groups （n=24） according to the treatment method. The patients in the observation group were treated with pedicle screw fixation through Wiltse approach plus implanted with injectable calcium sulfate bone cement, and those in the control group were subjected to pedicle screw fixation through posterior approach plus implanted with injectable calcium sulfate bone cement. The operation time, blood loss and hospitalization time were compared between two groups. The low back pain was observed at baseline, 1 week and 3 months postoperatively, and the percentage of anterior vertebral height revealed on X-ray was observed at baseline, before ambulation, and during last follow-up. Moreover, the complications, loosening and rupture of the screws were recorded.RESULTS AND CONCLUSION： （1） All patients were followed up, and the follow-up time was 16-24 months. （2） The operation time, blood loss and hospitalization time in the observation group were significantly less than those in the control group （P 〈 0.05）. （3） The postoperative visual analogue scale scores in the two groups were significantly lower than those before surgery, and the scores showed significant differences between two groups （P 〈 0.05）. （4） The percentage of anterior vertebral height

关 键 词：胸椎 腰椎 硫酸钙 骨折愈合 组织工程 骨科植入物 脊柱植入物 胸腰椎骨折 椎弓根钉 椎旁肌 微创 

分 类 号：R318[医药卫生—生物医学工程]