微创经皮椎弓根螺钉内固定间接复位合并椎体后上缘骨块胸腰椎爆裂性骨折的疗效观察  

Effect of percutaneous pedicle screw fixation on the reduction of thoraculumbar burst fractures with posterosuperior fracture fragment

作　　者：闫挺 吴超[1] 林旭[1] 曾俊[1] 钟泽莅[1] 谭伦[1] YAN Ting;WU Chao;LIN Xu;ZENG Jun;ZHONG Zeli;TAN Lun(Section Ⅰ,Department of Orthopaedics,the Fourth People's Hospital of Zigong,Zigong,Sichuan 643000,P.R.China)

机构地区：[1]自贡市第四人民医院骨一科,四川自贡643000

出　　处：《华西医学》2021年第10期1355-1360,共6页West China Medical Journal

基　　金：四川省科技计划项目(2016JY0108);四川省卫生和计划生育委员会科研课题(17PJ144)。

摘　　要：目的探讨微创经皮椎弓根螺钉内固定间接复位合并椎体后上缘骨块胸腰椎爆裂性骨折的临床疗效。方法回顾性收集2017年9月—2019年9月自贡市第四人民医院收治的胸腰椎骨折患者。采用微创经皮椎弓根螺钉内固定治疗,比较患者术前、术后3 d、术后1年的伤椎前缘高度比、椎体后上缘骨块翻转角、椎体后上缘骨块位移、椎管侵占率、后凸Cobb角、疼痛视觉模拟评分(Visual Analogue Scale,VAS)及Oswestry功能障碍指数(Oswestry Disability Index,ODI)。结果共纳入患者38例,均获1年以上随访,随访期间均未出现神经损伤、切口感染、内固定松动或断裂等并发症;手术时间为(91.7±10.4)min,术中出血量为(94.3±19.5)mL,手术切口长度为(9.3±1.8)cm。患者术后3 d伤椎前缘高度比、椎体后上缘骨块翻转角、椎体后上缘骨块位移、椎管侵占率、后凸Cobb角及术后1年伤椎前缘高度比、椎管侵占率、后凸Cobb角均较术前改善(P<0.05);术后1年,伤椎前缘高度比、椎管侵占率均较术后3 d降低(P<0.05),但后凸Cobb角高于术后3 d(P<0.05)。患者术后3 d及术后1年VAS评分、ODI指数均较术前改善(P<0.05),术后1年VAS评分、ODI指数亦均较术后3 d改善(P<0.05)。结论对于合并椎体后上缘骨块的无神经症状的胸腰椎爆裂性骨折,微创经皮椎弓根螺钉内固定能够较好地间接复位椎体后上缘骨块及恢复节段后凸角度,同时手术时间短、创伤小。Objective To explore the effectiveness of percutaneous pedicle screw fixation on the indirect reduction of posterosuperior fracture fragment in the thoraculumbar burst fractures.Methods Patients with thoracolumbar fractures treated in the Fourth People’s Hospital of Zigong from September 2017 to September 2019 were collected retrospectively.All patients were treated with percutaneous pedicle screw fixation.The main observation indexes before operation,3 days after operation and 1 year after operation were compared,including the height ratio of the anterior margin of fractured vertebra,the inversion angle of posterosuperior fracture fragment,the fragment displacement,the occupancy rate of spinal canal,the Cobb angle of kyphosisat,Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI).Results A total of 38 patients were included.All patients were followed up for more than 1 year.During the follow-up period,there were no complications such as nerve injury,incision infection,internal fixation loosening or fracture.The operation time was(91.7±10.4)min,the amount of intraoperative bleeding was(94.3±19.5)mL,and the length of surgical incision was(9.3±1.8)cm.The height ratio of the anterior margin of fractured vertebra,the inversion angle of posterosuperior fracture fragment,the fragment displacement,the occupancy rate of spinal canal,the Cobb angle of kyphosisat 3 days after operation were significantly improved compared with those before operation(P<0.05);the height ratio of the anterior margin of fractured vertebra,the occupancy rate of spinal canal,and the Cobb angle of kyphosisat 1 year after operation were also significantly improved compared with those before operation(P<0.05);the height ratio of the anterior margin of fractured vertebra and the occupancy rate of spinal canalat 1 year after operation were significantly improved than those 3 days after operation(P<0.05),but the Cobb angle of kyphosis 1 year after operation was significantly lost than that 3 days after operation(P<0.05).The VAS score and

关 键 词：经皮椎弓根螺钉内固定 胸腰椎爆裂性骨折 椎管侵占率 

分 类 号：R687.3[医药卫生—骨科学]