Mini-open后路显微镜下椎管减压治疗伴重度椎管狭窄的胸腰椎爆裂性骨折  

Decompression by mini-open posterior approach assisted with microscope for thoracolumbar burst fracture with severe spinal canal stenosis

作　　者：张斌 邹华 孔维军[1] 王翀[1] 伍富俊 叶盛[1] 王信[1] 敖俊[1] ZHANG Bin1,2, ZOU Hua1, KONG Weijun1, WANG Chong1, WU Fujun1, YE Sheng1, WANG Xin1, AO Jun1(1. Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P.R.China 2. Department of Spinal Surgery, Guizhou Orthopedic Hospital, Guiyang Guizhou, 550002, P.R.Chin)

机构地区：[1]遵义医学院附属医院骨科,贵州遵义563003 [2]贵州省骨科医院脊柱外科,贵阳550002

出　　处：《中国修复重建外科杂志》2018年第4期468-475,共8页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵州省科学技术基金项目(黔科合J字[2010]2179号);遵义医学院博士启动基金(遵医院办发[2010]19号)~~

摘　　要：目的探讨采用mini-open技术(mini-open technique,MOT)后路显微镜下椎管减压微创治疗伴重度椎管狭窄的胸腰椎爆裂性骨折的临床疗效。方法回顾分析2014年1月—2016年1月,采用MOT后路显微镜下行单侧或双侧椎板间隙开窗减压、撬拨复位、经椎管椎体内植骨、经皮椎弓根螺钉内固定治疗的伴重度椎管狭窄的28例胸腰椎爆裂性骨折患者临床资料。其中男21例,女7例;年龄16～61岁,平均42.1岁。受伤节段:T_(11) 1例,T_(12) 4例,L_1 14例,L_2 9例。AO分型:A3型19例,A4型9例。美国脊髓损伤协会(ASIA)神经功能分级:C级12例,D级13例,E级3例。受伤至手术时间3～7 d,平均3.6 d。比较手术前后疼痛视觉模拟评分(VAS)、伤椎前缘高度百分比、Cobb角、椎管狭窄率(rate of spinal compromise,RSC)及神经功能ASIA分级,评价临床疗效。结果患者均顺利完成手术,手术时间135～323 min,平均216.4 min;术中出血量80～800 m L,平均197.7 m L;住院时间10～25 d,平均12.5 d。术后切口均Ⅰ期愈合,无切口感染、脑脊液漏等早期并发症发生。28例均获随访,随访时间12～24个月,平均16.5个月。无内固定物松动、断裂发生;患者骨折均愈合,愈合时间3～12个月,平均6.5个月。术后即刻及末次随访时的伤椎前缘高度百分比、Cobb角及RSC,以及术后1 d及末次随访时的VAS评分均较术前显著改善(P<0.05);与末次随访时比较,术后即刻伤椎前缘高度百分比和Cobb角差异无统计学意义(P>0.05),术后即刻RSC及术后1 d VAS评分有显著改善(P<0.05)。末次随访时神经功能ASIA分级为C级1例、D级14例、E级13例,较术前显著改善(Z=3.860,P=0.000)。结论 MOT是治疗伴重度椎管狭窄的AO分型A3、A4型胸腰椎爆裂性骨折有效、微创的方法,有利于康复治疗早期介入。ObjectiveTo investigate the effectiveness of posterior microscopic mini-open technique （MOT） decompression in patients with severe spinal canal stenosis resulting from thoracolumbar burst fractures.MethodsThe clinical data of 28 patients with severe spinal canal stenosis caused by thoracolumbar burst fractures, who were treated by posterior microscopic MOT, which performed unilateral or bilateral laminectomy, poking reduction, intervertebral bone graft via spinal canal, and percutaneous pedicle screw fixation between January 2014 and January 2016 were retrospectively analyzed. There were 21 males and 7 females with a mean age of 42.1 years （range, 16-61 years）. The involved segments included T11 in 1 case, T12 in 4 cases, L1 in 14 cases, and L2 in 9 cases. According to AO classification, there were 19 cases of type A3, 9 of type A4. According to American Spinal Injury Association （ASIA） grading, 12 cases were grade C, 13 grade D, and 3 grade E. The time between injury and operation was 3-7 days （mean, 3.6 days）. To evaluate effectiveness, the changes in the visual analogue scale （VAS）, percentage of anterior height of injured vertebrae, Cobb angle, rate of spinal compromise （RSC）, and ASIA grading were analyzed.ResultsAll patients were performed procedures successfully. The operation time was 135-323 minutes （mean, 216.4 minutes）. The intraoperative blood loss was 80-800 mL （mean, 197.7 mL）. The hospitalization time was 10-25 days （mean, 12.5 days）. The incisions healed primarily, without wound infection, cerebrospinal fluid leakage, or other early complications. All the 28 patients were followed up 12-24 months （mean, 16.5 months）. No breakage or loosening of internal fixation occurred. All fractures healed, and the healing time was 3-12 months （mean, 6.5 months）. Compared with preoperative ones, the percentage of anterior height of injured vertebrae, Cobb angle, and RSC at immediate after operation and at last follow-up and the VAS scores at 1 day after operation and

关 键 词：胸腰椎爆裂性骨折 重度椎管狭窄 微创 显微镜 

分 类 号：R687.3[医药卫生—骨科学]