小切口减压固定伴神经损伤的胸腰椎骨折  

Small-incision decompression and pedicle screw fixation for thoracolumbar fractures accompanied with neurological impairments

作　　者：何一成 王长峰 杨乐[1] HE Yi-cheng;WANG Chang-feng;YANG Le(The Fourth Department of Surgery,Jiangsu General Hospital of Armed Police Forces,Yangzhou 225003,China)

机构地区：[1]中国人民武装警察部队江苏省总队医院外四科,江苏扬州225003

出　　处：《中国矫形外科杂志》2020年第14期1264-1268,共5页Orthopedic Journal of China

摘　　要：[目的]探讨小切口减压固定治疗胸腰椎骨折伴神经损伤的临床效果。[方法]回顾分析2015年2月~2018年12月采用椎弓根螺钉内固定联合椎管减压治疗的伴神经损伤胸腰椎骨折患者108例。依据医患沟通将患者分为两组,52例采用小切口手术,56例采用常规后路开放手术。比较两组患者围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,未出现术中严重并发症。小切口组患者的手术时间、术中出血量、术后引流量及住院时间均显著低于常规组(P<0.05)。随时间推移,两组患者的VAS和ODI评分均显著减少(P<0.05),JOA评分显著增加(P<0.05),ASIA评级显著改善(P<0.05)。末次随访时,小切口组患者VAS和ODI评分显著低于常规组(P<0.05),而小切口组JOA评分显著高于常规组(P<0.05),但两组间ASIA评级的差异无统计学意义(P>0.05)。影像方面,术后两组患者α、AVH均显著大于术前,而CA均显著小于术前(P<0.05)。末次随访时,小切口组患者上述各指标均显著优于常规组(P<0.05)。[结论]小切口减压固定术是治疗胸腰椎骨折伴神经损伤微创、安全、高效的手术方式。[Objective] To evaluate the clinical outcomes of small-incision decompression and pedicle screw fixation for thoracolumbar fractures accompanied with neurological impairments.[Methods] A retrospective study was conducted on 108 patients who received surgical decompression and pedicle screw fixation for thoracolumbar fractures with nerve impairments in our department from February 2015 to December 2018.Based on results of doctor-patients communication,52 patients had surgical procedures finished through small incisions,while the remaining 56 patients had operation performed through a conventional posterior midline incision.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results] All patients in both groups had operation conducted successfully without serious intraoperative complications.The small-incision group was significantly superior to the conventional group regarding to operation time,intraoperative bleeding volume,postoperative drainage volume and hospitalization time(P<0.05).The VAS and ODI scores significantly decreased,while the JOA score significantly increased and the ASIA scale significantly improved over time in both groups(P<0.05).The small-incision group proved significantly superior to the conventional group in VAS,ODI and JOA scores(P<0.05),regardless no a statistical difference in ASIA scale between them at the latest follow up(P>0.05).With regard to radiographic assessment,the patency of spinal canal(α),anterior vertebral height and Gobb’s angle significantly improved after operation compared with those preoperatively in both groups(P<0.05).The small-incision group also proved significantly superior to the conventional group in aforesaid imaging items at the latest follow up(P<0.05).[Conclusion] The small-incision decompression and pedicle screw fixation are minimally invasive,safe and highly efficient treatment for thoracolumbar fractures accompanied with neurological impairments.

关 键 词：胸腰椎骨折 神经损伤 小切口 椎弓根内固定 椎管减压 

分 类 号：R683.2[医药卫生—骨科学]