单节段椎弓根钉内固定结合经椎间孔胸腰椎椎间融合术治疗胸腰椎爆裂性骨折的临床疗效  

Clinical efficacy of monosegmental pedicle screw fixation combined with transforaminal thoracolumbar interbody fusion in the treatment of thoracolumbar burst fractures

作　　者：钟华璋 田大胜[1] 陈磊[1] 朱斌[1] 荆珏华[1] ZHONG Hua-zhang;TIAN Da-sheng;CHEN Lei;ZHU Bin;JIN Jue-hua(Department of Spine Surgery,The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院脊柱外科,安徽合肥230601

出　　处：《颈腰痛杂志》2023年第2期186-188,192,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的探讨应用椎弓根钉固定单一运动节段并结合经椎间孔椎间融合术治疗A3型胸腰椎爆裂性骨折的临床疗效。方法回顾性分析2018年1月~2020年12月本科应用单节段椎弓根螺钉内固定结合经椎间孔胸腰椎椎间融合术治疗的35例A3型胸腰椎爆裂性骨折患者病历资料,其中男23例,女12例;年龄21~64岁,平均(43.9±9.5)岁;6例伴神经功能损伤,改良Frankel分级均为D级。统计手术情况,并随访观察术后疗效。结果35例患者手术时间75~165 min,平均(116.8±20.8)min;术中出血量180~410 mL,平均(276.3±57.2)mL;6例伴神经损伤患者,术后2周内均痊愈。2例因术中操作不当导致硬膜损伤,1例术后发生切口感染,均对症处理后痊愈。随访时间14~50个月,平均(32.7±8.7)个月。与术前相比,患者术后和末次随访时的VAS评分、矢状面Cobb角、伤椎前缘高度压缩率均显著改善(P<0.05);与术后相比,患者末次随访时的椎体矫正效果无明显丢失(P>0.05),但VAS评分则进一步改善(P<0.05)。所有患者均达到骨性融合,融合时间4~9个月,平均(6.0±1.2)个月。结论单节段椎弓根钉内固定结合经椎间孔胸腰椎椎间融合术治疗胸腰椎爆裂性骨折,可即刻重建伤椎椎体高度、恢复脊柱稳定,防止后凸畸形及伤椎再塌陷,疗效满意。Objective To investigate the clinical efficacy of pedicle screw fixation of amonosegment combined with transforaminal discectomy and interbody fusion in the treatment of type A3 thoracolumbar burst fractures.Methods From January 2018 to December 2020,35 patients with thoracolumbar burst fractures treated with monosegmental pedicle screw fixation combined with transforaminal thoracolumbar interbody fusion were retrospectively analyzed.AO classification showed A3 fractures,including 23 males and 12 females;The average age was 43.9±9.5 years(range,21-64 years).6 patients had neurological impairment,all of which were grade D according to the modified Frankel classification.The surgical situation was counted,and their clinical effects were observed at follow-up.Results In 35 patients,the operative time ranged from 75 to 165 min,with a mean of(116.8±20.8)min;the intraoperative bleeding volume ranged from 180 to 410 mL,with a mean of(276.3±57.2)mL;6 patients with nerve injury were cured within 2 weeks after surgery;2 cases had dural injury due to improper operation and 1 case had incisional infection after surgery,which were cured after symptomatic treatment.The follow-up period ranged from 14 to 50 months,with a mean of(32.7±8.7)months.The patients'VAS scores,sagittal Cobb angle,and height compression rate at the anterior edge of the injured spine were significantly improved postoperatively and at the last follow-up compared with preoperatively(P<0.05);The patients had no significant loss of vertebral correction at the last follow-up compared with the postoperative period(P>0.05),but VAS scores were further improved(P<0.05).All patients achieved bony fusion with a mean of(6.0±1.2)months from 4 to 9 months of fusion.Conclusion Monosegmental pedicle screw fixation combined with transforaminal thoracolumbar interbody fusion in the treatment of thoracolumbar burst fractures can immediately reconstruct the height of the injured vertebra,restore spine stability,prevent kyphosis and re-collapse of the injured vertebra,an

关 键 词：胸腰椎骨折 椎间融合 椎弓根钉 单节段固定 

分 类 号：R683.2[医药卫生—骨科学]