经皮与开放减压固定胸腰骨折伴神经损伤的比较  

Percutaneous versus open pedicle screw fixation combined with decompression for thoracolumbar fractures accompanied with nerve injury

作　　者：宋鑫[1] 张锋 韩帅 任东林 王健[1] SONG Xin;ZHANG Feng;HAN Shuai;REN Dong-lin;WANG Jian(Department of Orthopaedics,Peoples,Hospital of Shanghai Pudong New Area,Shanghai 201299,China)

机构地区：[1]上海市浦东新区人民医院骨科,上海201299

出　　处：《中国矫形外科杂志》2021年第22期2053-2058,共6页Orthopedic Journal of China

基　　金：上海市浦东新区卫生和计划生育委员会学科带头人培养计划任务(编号:PWRd2017-08);上海市浦东新区卫生系统优秀青年医学人才培养计划(编号:PWRq2020-18);上海市浦东新区卫生系统重点亚专科建设项目(编号:PWZy2020-04)。

摘　　要：[目的]对比经皮椎弓根钉内固定(percutaneous pedicle screw fixation,PPSF)与开放椎弓根钉内固定(open pedicle screw fixation,0PSF)治疗合并神经损伤的胸腰段骨折的临床效果。[方法]回顾性分析2018年1月一2020年1月在本院接受手术治疗的单节段A0分型A3型胸腰段脊柱骨折63例患者的临床资料。其中,26例采用PPSF联合后正中人路Quadrant通道下椎管减压复位术(PPSF组),37例采用椎弓根钉内固定联合椎板切除减压术(0PSF组)。比较两组围手术期、随访和影像学资料。[结果]两组患者均顺利完成手术。PPSF组的手术时间和术中透视次数显著大于0PSF组(P<0.05),但是,PPSF组的切口长度、术中失血量和术后住院时间均显著小于0PSF组(P<0.05),术后3d和7d,PPSF组的血液CK水平均显著低于0PSF组(P<0.05)。所有患者随访12~18个月,平均(15.63±2.29)个月。随时间推移,两组患者ASIA神经功能评级均显著改善(P<0.05),相应时间点两组ASIA神经功能评级的差异均无统计学意义(P<0.05)。随时间推移,两组患者VAS、0DI评分均逐渐下降(P<0.05);术后3个月和末次随访时,PPSF组的VAS和0DI评分均显著优于0PSF组(P<0.05)。影像方面,与术前相比,术后3个月两组患者椎体前、后缘高度比均显著增加(P<0.05),而后凸Cobb角显著减小(P<0.05)。术后3个月和末次随访时,PPSF组的后缘高度比和后凸Cobb角均显著优于0PSF组(P<0.05)。[结论]相比OPSF,PPSF治疗合并神经损伤胸腰椎骨折手术创伤小,神经功能恢复效果相似。[Objective]To compare the clinical outcomes of percutaneous pedicle screw fixation(PPSF)versus open pedicle screw fixation(OPSF)for thoracolumbar fractures accompanied with nerve injury.[Methods]A retrospective study was conducted on 63 patients who underwent surgical treatment for AO type A3 thoracolumbar fractures accompanied with nerve injury from January 2018 to January 2020.Of them,26 patients received PPSF combined with minimally invasive decompression and reduction under quadrant tube via posterior mid-line approach(the PPSF group),while the other 37 patients were treated with OPSF combined with laminectomy and decompression(the OPSF group).The perioperative,follow-up and radiographic data were compared between the two groups.[Results]All patients in both groups were operated on successfully.Although the PPSF group were significantly greater in terms of operation time and fluoroscopic frequency than the OPSF group(P<0.05),the former were significantly less in terms of incision length,intraoperative blood loss and hospital stay than the latter(P<0.05).In addition,the PPSF group had significantly lower serum creatine kinase(CK)at 3 and 7 days postoperative-ly than the OPSF group(P<O.O5).All patients in both groups were followed up for 12〜18 months with an average of(15.63±2.29)months.The ASIA grade for neurological function significantly improved over time in both groups(P<0.05),which was not statistically significant between the two groups at any corresponding time points(P>0.05).The VAS and ODI scores decreased significantly in both groups as time went on(P<0.05).The PPSF group proved significantly superior to the OPSF group in terms of abovementioned scores at 3 months postop-eratively and the latest follow-up(P<0.05).Regarding to radiographic assessment,the anterior vertebral height ratio(AVHR),posterior vertebral height ratio(PVHR)significantly increased,whereas the local kyphotic Cobb angle significantly decreased in both groups postop eratively compared with those before operation(P<0.05).The PPSF

关 键 词：胸腰椎骨折 神经损伤 经皮椎弓根钉内固定术 开放椎弓根钉内固定术 微创椎管减压 

分 类 号：R683.2[医药卫生—骨科学]