经皮终板复位螺钉技术结合短节段经皮螺钉内固定治疗A3型胸腰椎骨折的近期疗效  

Short-term efficacy of percutaneous endplate reduction percutaneous pedicle screw technique plus short-segment percutaneous pedicle screw internal fixation for type A3 thoracolumbar fractures

作　　者：丁舒晨 刘志荣 潘洪 卢一生 Ding Shuchen;Liu Zhirong;Pan Hong;Lu Yisheng(Department of Orthopedic Surgery,903rd Hospital of People's Liberation Army Joint Logistics Support Force,Hangzhou 310001,China)

机构地区：[1]解放军联勤保障部队第903医院骨科中心,杭州310001

出　　处：《中华创伤杂志》2019年第6期527-533,共7页Chinese Journal of Trauma

基　　金：杭州市卫生计生科技计划(2016B62).

摘　　要：目的探讨应用经皮终板复位螺钉(ERPPS)技术结合短节段经皮椎弓根螺钉内固定治疗AO分型A3型胸腰椎骨折的可行性及近期疗效。方法采用回顾性病例对照研究分析2015年12月—2018年1月解放军联勤保障部队第903医院收治的36例无神经症状且伴终板粉碎的A3型胸腰椎骨折患者临床资料。15例采用ERPPS技术结合短节段经皮椎弓根螺钉内固定治疗(A组),其中男11例,女4例;年龄(37.9±8.3)岁。损伤节段:T11 1例,T12 3例,L1 6例,L2 3例,L3 2例。21例同期采用单纯短节段经皮椎弓根螺钉复位内固定治疗(B组),其中男14例,女7例;年龄(37.3±9.5)岁。损伤节段:T11 2例,T12 6例,L1 7例,L2 4例,L3 2例。记录手术时间、术中出血量及并发症发生情况。根据术前、术中经常规方法复位后、术后3 d及术后6个月随访时所摄X线片测量并计算伤椎椎体前缘高度百分比(AVBHr)、椎体中部高度百分比(MVBHr)、椎体后缘高度百分比(PVBHr)、后凸Cobb角及伤椎楔形角。采用视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评估疼痛和功能改善情况。结果患者均获随访11~30个月[(19.1±5.0)个月]。手术时间A组为(62.8±4.4)min,B组为(60.1±4.7)min(P>0.05)。术中出血量A组为(48.5±5.1)ml,B组为(48.0±4.9)ml(P>0.05)。术后切口均Ⅰ期愈合,无相关并发症发生。术后3 d,A组伤椎MVBHr为(84.8±4.4)%,B组为(68.1±8.8)%(P<0.05);术后6个月,A组伤椎MVBHr为(81.3±4.9)%,显著优于B组的(63.6±8.1)%(P<0.05)。术后6个月,A组后凸Cobb角[(11.3±3.2)°]、伤椎楔形角[(10.5±2.1)°]及VAS[(1.1±0.7)分]均显著低于B组[(13.4±2.3)°、(12.1±2.2)°、(1.9±1.1)分](P均<0.05)。两组AVBHr、PVBHr及ODI差异均无统计学意义(P均>0.05)。结论对于无神经症状且伴终板粉碎的A3型胸腰椎骨折,ERPPS技术可有效复位上终板中央部的塌陷,减少短节段经皮椎弓根螺钉复位内固定术后的复位丢失并减轻腰痛症状。Objective To investigate the feasibility and short-term efficacy of endplate reduction percutaneous pedicle screw(ERPPS)technique combined with short-segment percutaneous pedicle screw fixation for the treatment of AO type A3 thoracolumbar fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 36 patients with type A3 thoracolumbar fractures without neurological symptoms and with comminuted endplates admitted to 903 Hospital of PLA from December 2015 to January 2018.Fifteen patients(Group A)were treated with ERPPS technique combined with short-segment percutaneous pedicle screw fixation,including 11 males and four females,aged(37.9±8.3)years.The injured segments were at T11 in 1 patient,T12 in 3,L1 in 6,L2 in 3 and L3 in 2.Simple short-segment percutaneous pedicle screw reduction and internal fixation was performed in 21 patients(Group B),including 14 males and seven females,aged(37.3±9.5)years.The injured segments were at T11 in two patients,T12 in six,L1 in seven,L2 in four and L3 in two patients.The operation time,intraoperative bleeding and complications were recorded.The anterior vertebral body height ratioin(AVBHr),middle vertebral body height ratio(MVBHr),posterior vertebral body height ratio(PVBHr),Cobb angle of kyphosis and wedge angle of injured vertebrae were calculated based on the measurement by X-ray films taken before operation,during operation(after regular reduction),3 days after operation and 6 months after operation.Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were used to assess the pain and functional improvement.Results All patients were followed up for 11-30 months[(19.1±5.0)months].The operation time was(62.8±4.4)minutes in Group A and(60.1±4.7)minutes in Group B(P>0.05).The intraoperative blood loss was(48.5±5.1)ml in Group A and(48.0±4.9)ml in Group B(P>0.05).All the incisions were healed by first intention without complications.The MVBHr of injured vertebra was(84.8±4.4)%in Group A and(68.1±8.8)%in Group B(P<0.05).The

关 键 词：脊柱骨折 骨折固定术 内 椎弓根螺钉 

分 类 号：R687.3[医药卫生—骨科学]