经皮椎弓根螺钉治疗胸腰椎爆裂骨折伴椎管占位疗效分析  

Clinical Analysis of Percutaneous Pedicle Screw in Treatment of Thoracolumbar Burst Fracture with Space Occupying Vertebral Canal

作　　者：熊靖 刘权祥 程维[1] XIONG Jing;LIU Quanxiang;CHENG Wei(Affiliated Hospital of Beihua University,Jilin 132011,China)

机构地区：[1]北华大学附属医院,吉林吉林132011

出　　处：《北华大学学报（自然科学版）》2022年第3期365-369,共5页Journal of Beihua University（Natural Science）

基　　金：吉林省教育厅科学技术研究项目(JJKH20220074KJ,JJKH20180364KJ);吉林省卫生健康技术创新项目(2019J047).

摘　　要：目的探讨经皮椎弓根螺钉技术(Percutaneous pedicle screw fixation PPSF)治疗胸腰椎爆裂骨折伴椎管内骨折块占位的疗效.方法对胸腰椎爆裂骨折伴椎管内骨折块占位的60例患者均采用PPSF撑开复位、间接减压及内固定手术治疗,且全部获得术后随访.结果功能学评价指标采用VAS评分、ODI指数、JOA评分进行评价.患者术前、术后1周、术后6个月、末次随访患者VAS评分、ODI评分逐步减少,JOA评分增加(P<0.05).影像学评价指标采用伤椎前缘高度百分比(RAVH)、Cobb角、椎管侵占率进行评价.患者术后1周与术前比较,RAVH、Cobb角明显恢复(P<0.05);术后6个月与术后1周比较,RAVH、Cobb角稍有丢失(P>0.05),末次随访与术后6个月比较,RAVH、Cobb角稍有丢失(P>0.05).随时间推移,椎管侵占率逐步减小(P<0.05).结论应用PPSF治疗胸腰椎爆裂骨折伴椎管内骨折块占位,能有效复位回纳骨折块,减压效果明确,脊柱稳定性恢复好,对伤椎附近组织损伤小.Objective To investigate the efficacy of percutaneous pedicle screw fixation(PPSF)in the treatment of thoracolumbar burst fractures with intra spinal fracture mass occupation.Method 60 patients with thoracolumbar burst fracture and intraspinal fracture mass occupying were treated with PPSF distraction reduction,indirect decompression and internal fixation.All patients were followed up after operation.Results The functional evaluation indexes were VAS score,ODI index,JOA score.VAS score and ODI score decreased gradually and JOA score increased before operation,1 week after operation,6 months after operation and the last follow-up(P<0.05).The imaging evaluation indexes were ratio of anterior vertebral height(RAVH),Cobb angle,spinal canal invasion rate,RAVH and Cobb angles recovered significantly after 1 week operation compared with those before operation(P<0.05);RAVH and Cobb angle were slightly lost at 6 months after operation compared with after 1 week operation,and the difference was not statistically significant(P>0.05).RAVH and Cobb angle were slightly lost at the last follow-up compared with 6 months after operation,and the difference was not statistically significant(P>0.05).With the passage of time,the spinal canal invasion rate gradually decreased,and the difference was statistically significant(P<0.05).Conclusion PPSF in the treatment of thoracolumbar burst fracture with intraspinal fracture mass occupation can effectively reduce and retract the fracture mass,with clear decompression effect,good spinal stability and less damage to the tissue near the injured vertebra,which is worthy of further research and popularization.

关 键 词：经皮椎弓根螺钉 胸腰椎骨折 椎管占位 

分 类 号：R683.2[医药卫生—骨科学]