经皮通道微创治疗胸腰椎爆裂骨折的疗效分析  

Curative effect of percutaneous channel minimally invasive treatment for thoracolumbar burst fractures

作　　者：孔雷[1] 黄炎 李旭[1] 张文志 KONG Lei;HUANG Yan;LI Xu;ZHANG Wen-zhi(Department of Spinal Surgery,The First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei,Anhui,230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)脊柱外科,安徽合肥230001

出　　处：《颈腰痛杂志》2022年第4期493-496,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的观察比较经皮椎弓根螺钉联合通道减压和传统后路开放椎管减压治疗胸腰椎爆裂骨折的手术疗效。方法回顾2018年4月~2019年12月收住胸腰椎爆裂骨折伴神经功能受损的手术患者,其中21例行经皮椎弓根螺钉内固定联合通道微创减压(微创组),23例行传统开放减压手术(开放组),记录并比较两组围手术期指标和术后疗效指标。结果微创组术中出血量显著少于开放组,术中透视次数显著多于开放组(P<0.05);两组手术时间差异无统计学意义(P>0.05)。随访16~26个月,两组术后VAS评分、损伤椎体前后缘高度比、后凸Cobb角均较术前明显改善(P<0.05);两组间比较,术后第2天和3个月的腰痛VAS评分有统计学差异(P<0.05)。两组术后神经功能至少改善1个ASIA分级,但组间无显著差异(P>0.05)。结论与开放手术相比,经皮椎弓根钉内固定联合通道显微镜减压治疗胸腰椎骨折伴神经功能损害患者,术中椎管减压彻底,创伤小、术后恢复快、疗效可靠。Objective To observe and compare the surgical effects of percutaneous pedicle screw combined channel decompression and traditional posterior open spinal canal decompression in the treatment of thoracolumbar burst fractures.Methods From April 2018 to December 2019,the clinical data of surgical patients with thoracolumbar burst fractures and neurological impairment were reviewed.Twenty-one patients underwent percutaneous pedicle screw internal fixation combined with channel minimally invasive decompression were selected as minimally invasive group,and 23 patients underwent traditional open decompression surgery were selected as open group.The perioperative indicators and postoperative efficacy indicators of the two groups were recorded and compared.Results The amount of intraoperative bleeding in the minimally invasive group was significantly less than that in the open group,and the number of intraoperative fluoroscopy was significantly more than that in the open group(P<0.05).There was no significant difference in operation time between the two groups(P>0.05).After 16~26 months of follow-up,the VAS score,the height ratio of the anterior and posterior edge of the injured vertebral body and the kyphosis Cobb angle in the two groups were significantly improved(P<0.05).Compared between the two groups,the VAS score of low back pain on the 2nd day and 3 months after operation was statistically different(P<0.05).The neurological function of the two groups improved by at least 1 ASIA grade,but there was no significant difference between the two groups(P>0.05).Conclusion Compared with the open group,percutaneous pedicle screw internal fixation combined with channel microscope decompression in the treatment of thoracolumbar fractures with neurological impairment can achieve thorough intraoperative spinal canal decompression,with less trauma,faster postoperative recovery,and reliable curative effect.

关 键 词：通道 脊髓损伤 经皮椎弓根螺钉 胸腰椎骨折 

分 类 号：R683.2[医药卫生—骨科学]