Endoring自撑拉钩辅助微创小切口前路单节段减压固定融合治疗DenisB型胸腰椎爆裂骨折  

Treatment of Denis type B thoracolumbar burst fractures by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach

作　　者：陈康[1] 曾建成[1] 修鹏[1] 宋跃明[1] 刘浩[1] 刘立岷[1] 龚全[1] 李涛[1] 孔清泉[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华创伤杂志》2017年第12期1065-1071,共7页Chinese Journal of Trauma

摘　　要：目的探讨Endoring自撑拉钩辅助下微创小切口前路减压固定融合治疗DenisB型胸腰椎爆裂骨折的临床疗效。方法采用回顾性病例系列研究分析2007年1月-2009年6月采用Endoring自撑拉钩辅助下微创小切口前路减压固定融合治疗的26例DenisB型胸腰椎爆裂骨折患者临床资料，其中男14例，女12例；年龄18～68岁，平均48．5岁。损伤节段：T1 3例，L1 18例，L2 5例。术前美国脊髓损伤协会（ASIA）分级：C级8例，D级12例，E级6例。记录手术时间、术中出血量、切口长度及术后并发症。术后3，6，12个月及之后每年随访神经功能、腰背痛视觉模拟评分（VAS）、后凸及高度丢失矫正等情况。末次随访根据三维CT检查采用改良Brantigan法评价植骨融合情况。结果患者均顺利完成手术，手术时间（214．6±30．5）min，术中出血量（389．7±57．1）ml，切口长度（8．5±1．3）cm。患者均获随访5～7年[（6．3±0．4）年]。末次随访时20例ASIA分级均有l级以上的神经功能改善，腰背痛VAS由术前的（7．8±1．6）分改善为（2．1±0．8）分（P〈0．05）。术前椎间高度为（29．8±5．3）mm，末次随访时为（35．2±2．4）mm（P〈0．05）。术前Cobb角为（20．4±11．7）°，末次随访时为（11．3±5．5）°（P〈0．05）。患者均获得植骨融合，随访期间无内固定松动、断裂或移位发生。结论采用Endoring自撑拉钩辅助小切口前路单节段减压固定融合术具有手术创伤小、充分椎管减压、矫正后凸畸形、固定节段短、植骨融合率高等优点，是治疗DenisB型胸腰椎爆裂骨折安全、有效、微创的手术方法。Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures. Methods A retrospective case series study was made on 26 cases （ 14 males and 12 females, mean age of 48.5 years） of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009. Age was 18-68 years （ mean, 48.5 years）. The fractured vertebrae included T1 in three cases, L1 in 18 and L2 in five. The neurological status was Grade C in eight cases, Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association （ASIA） classification. The operation duration, blood loss and incision length were recorded. The neurological function, lower back pain were evaluated by visual analogue score （ VAS ） , correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3, 6 and 9 months and annually after surgery. The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up. Results All patients were successfully managed with this approach. The operation duration was （214.6 ± 30.5）min, and the intraoperative blood loss was （389.7 ± 57.1 ） ml. The length of incision was （8.5± 1.3 ） cm. All patients were followed up for （ 6.3 ± 0.4） years. At final follow-up, the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade. The VAS of lower back pain was improved from preoperative （7.8 ± 1.6） points to （2.1 ± 0.8 ） points at final follow-up （ P 〈 0. 05 ）. The height of the intervertebral body was restored from preoperative （29.8 ± 5.3 ）mm to （ 35.2 ± 2.4 ）

关 键 词：脊柱骨折 胸椎 腰椎 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]