后路减压椎弓根螺钉固定与单纯后路椎弓根螺钉固定治疗单节段胸腰椎骨折合并椎板青枝骨折  

Comparison on curative effect of posterior decompression pedicle screw fixation and single posterior pedicle screw fixation for thoracolumbar fracture with greenstick lamina fracture

作　　者：陈志达[1] 林斌[1] 戴立林 黄砖枝[1] 姚小涛[1] 蔡弢艺[1] Chen Zhida;Lin Bin;Dai Lilin;Huang Zhuanzhi;Yao Xiaotao;Cai Taoyi(Department of Orthopedics, Orthopedic Center of PLA, 909th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Zhangzhou 363000, China)

机构地区：[1]解放军联勤保障部队第909医院(厦门大学附属东南医院)全军骨科中心,漳州363000

出　　处：《中华创伤杂志》2019年第10期880-887,共8页Chinese Journal of Trauma

基　　金：原南京军区医学科技创新项目(12Z24).

摘　　要：目的探讨后路减压椎弓根螺钉固定与单纯椎弓根螺钉固定治疗胸腰椎骨折合并椎板青枝骨折的疗效。方法采用回顾性病例系列研究分析2011年1月— 2016年5月解放军联勤保障部队第909医院收治的106例急性胸腰椎骨折合并椎板青枝骨折患者临床资料,其中男68例,女38例;年龄21~58岁[(39.5±7.1)岁]。伤椎分布:T11 9例,T12 16例,L1 28例,L2 42例,L3 11例。58例行后路减压椎弓根螺钉固定术,其中男37例,女21例;年龄23~58岁[(38.7±6.6)岁]。美国脊髓损伤协会(ASIA)分级:A级3例,B级9例,C级14例,D级27例,E级5例。48例行单纯后路椎弓根螺钉固定术,其中男31例,女17例;年龄21~57岁[(41.4 ± 5.8)岁]。记录手术时间、术中出血量、伤椎前缘高度比、矢状面Cobb角、视觉模拟评分(VAS)、ASIA分级、硬脊膜破裂和(或)神经根卡压及并发症发生情况。结果患者均获随访24~72个月[(30.2±4.7)个月]。后路减压椎弓根螺钉固定手术时间为105~137 min[(113.5±21.3)min];术中出血量为235~310 ml[(252.2±28.6)ml]。单纯后路椎弓根螺钉固定手术时间为52~85 min[(65.3±9.6)min];术中出血量为72~125 ml[(90.2±23.6)ml]。患者术后即刻及末次随访的伤椎前缘高度比、矢状面Cobb角、VAS均较术前明显改善(均P<0.01)。术后1年随访时,单纯后路椎弓根螺钉固定患者的神经功能ASIA分级与术前相同,而后路减压椎弓根螺钉固定患者的神经功能ASIA分级较术前显著提高(P<0. 01)。后路减压椎弓螺钉固定患者术中减压时发现硬脊膜破裂12例,马尾神经卡压5例;3例行单纯后路椎弓根钉固定术后出现神经损伤,再次行后路减压手术,术中均发现硬脊膜破裂和(或)马尾神经卡压于椎板青枝骨折中。患者均未出现内固定相关并发症。结论后路减压椎弓根螺钉及单纯后路椎弓根螺钉固定治疗胸腰椎骨折合并椎板青枝骨折均能有效矫正后凸畸形、恢复椎体高度、减轻疼痛并促进Objective To investigate the efficacy of posterior decompression pedicle screw fixation and single pedicle screw fixation for thoracolumbar fracture with greenstick lamina fracture. Methods A retrospective case series study was conducted to analyze the clinical data of 106 patients with thoracolumbar fractures combined with greenstick lamina fractures admitted to the 909th hospital from January 2011 to May 2016. There were 68 males and 38 females, aged 21-58 years [(39.5±7.1)years]. The fracture was located at T11 in 9 patients, at T12 in 6, at L1 in 28, at L3 in 11. A total of 58 patients underwent posterior decompression pedicle screw fixation including 37 males and 21 females, aged 23-58 years [(38.7±6.6)years]. The preoperative neurological function was evaluated according to ASIA grade: grade A for three patients, grade B for nine, grade C for 14, grade D for 27, and grade E for 53 patients. A total of 48 patients were treated with single posterior pedicle screws fixation including 31 males and 17 females, aged 21-57 years [(41.4±5.8)years]. Statistical indicators included operation time, intraoperative blood loss, anterior height ratio of injured vertebrae, sagittal Cobb angle, visual analogue scale (VAS), ASIA grading, dural tears and/or cauda equina entrapment, and complications. Results All patients were followed up for 24-72 months [(30.2±4.7)months]. The operation time ranged from 105 to 137 minutes [(113.5±21.3)minutes], and the intraoperative blood loss was 235-310 ml [(252.2±28.6)ml] in the posterior decompression and pedicle screws fixation group. In the posterior pedicle screw fixation group, the operation time ranged from 52 to 85 minutes [(65.3±9.6)minutes], and the intraoperative blood loss was 72-125 ml [(90.2±23.6)ml]. The anterior height ratio of injured vertebrae, sagittal Cobb angle and VAS score of the two groups were significantly improved immediately after operation and at the last follow-up (all P<0.01). At one year follow up, the ASIA grading in patients treated with single po

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]