经皮微创长节段固定不稳定胸腰椎骨折疗效分析  

Percutaneous minimally invasive fixation of unstable thoracolumbar fractures with long segment pedicle screws

作　　者：陈新用 杨庆 翟启麟 蒋凯 陶星光 龚东亮 CHEN Xinyong;YANG Qing;ZHAI Qilin;JIANG Kai;TAO Xingguang;GONG Dongliang(Orthopedic Surgery,Qingpu Branch,Zhongshan Hospital affiliated to Fudan University, Shanghai 201700, China)

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201700

出　　处：《国际骨科学杂志》2021年第1期54-58,共5页International Journal of Orthopaedics

基　　金：上海市青浦区卫生和计划生育委员会科研课题(W2018-16);上海市青浦区卫生和健康委员会学科人才专项资助(WY2019-02)。

摘　　要：目的探讨经皮微创椎弓根螺钉长节段内固定治疗胸腰椎骨折的临床疗效。方法对22例无神经症状的胸腰椎不稳定性骨折患者采用经皮微创椎弓根螺钉系统进行撑开复位长节段内固定。观察手术时间、术中出血情况,手术前后椎体前缘高度、Cobb角改变,手术后腰椎恢复情况。结果手术时间(60±12)min(45~90 min),术中出血量(15±7)mL(10~40 mL),术后随访(20±6)个月(12~36)个月。术后12~18个月拆除内固定14例。Cobb角术前、术后3 d、末次随访时分别为17.86°±2.42°、2.85°±0.86°、3.88°±1.05°,术后3 d较术前改善(P<0.05),末次随访时较术前改善(P<0.05)。椎体前缘高度术前、术后3 d、末次随访时分别为(17.19±2.33)mm、(29.51±2.62)mm、(28.99±2.58)mm,术后3 d较术前改善(P<0.05),末次随访时较术前改善(P<0.05)。末次随访椎体前缘塌陷恢复率为(95.4±11.5)%,术后3 d Cobb角纠正率为(78.2±8.6)%。疼痛视觉模拟评分术前、术后3 d、末次随访时分别为(8.3±0.7)分、(5.2±0.5)分、(1.8±0.4)分,术后3 d较术前改善(P<0.05),末次随访时较术前改善(P<0.05)。Oswestry功能障碍指数术前、术后3 d、末次随访时分别为(84.3±7.2)%、(54.2±3.2)%、(8.7±0.4)%,术后3 d较术前改善(P<0.05),末次随访时较术前改善(P<0.05)。所有病例未发生神经损伤、内固定失败、腰背部疼痛及腰椎失能。结论经皮微创椎弓根螺钉长节段内固定治疗不稳定性胸腰椎骨折,具有安全有效、损伤小、出血少、恢复快且美观的优点。Objective To investigate the clinical results of percutaneous minimally invasive fixation for unstable thoracolumbar fractures with long segment pedicle screw.Methods A total of 22 patients suffering thoracolumbar unstable fractures without neurological symptoms were treated with percutaneous minimally invasive fixation with long segment pedicle screws.The operation duration,intraoperative blood loss,preoperative and postoperative height of anterior margin of vertebra body,Cobb angle of kyphosis and lumbar vertebra recovery were observed and analyzed.Results The operation duration was 45 to 90 min,with an average of(60±12)min;the intraoperative blood loss volume was 10 to 40 mL,with an average of(15±7)mL;and the postoperative follow-up was 12 to 36 months,with an average of(20±6)months.The implants in 14 cases were removed after 12 to 18 months postoperatively.The Cobb angle was 17.86°±2.42°before operation,2.85°±0.86°at 3 days after operation and 3.88°±1.05°at the latest follow-up.The anterior height of the fractured vertebral body were(17.19±2.33)mm preoperativerly,(29.51±2.62)mm at 3 days postoperatively,and(28.99±2.58)mm at the latest follow-up,with statistically significant improvement compared with that preoperatively(P<0.05).The average correction rate of the anterior collapse of the vertebral body was(95.4±11.5)%at the latest follow-up,and the average Cobb Angle correction rate was(78.2±8.6)%at 3 days after operation.The VAS score was 8.3±0.7 before operation,5.2±0.5 at 3 days after operation and 1.8±0.4 at the latest follow-up;the ODI was(84.3±7.2)%preoperatively,(54.2±3.2)%at 3 days postoperatively,and(8.7±0.4)%at the latest follow-up;all these values were improved significantly compared with their corresponding parameters preoperatively(P<0.05).No nerve injury,failure of internal fixation,low back pain or lumbar incapacitation occurred in all patients.Conclusion Percutaneous minimally invasive fixation for thoracolumbar fractures with long segment pedicle screws may be an effecti

关 键 词：微创 胸腰椎骨折 内固定 

分 类 号：R68[医药卫生—骨科学]