肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗胸腰椎骨折  

Short segmental pedicle screw-rod fixation combined with bone grafting through the fractured vertebral pedicle on the thoracolumbar fractures with Wiltse approach

作　　者：林凯路 朱浩玮 黄小敬 谢路 吕亮 LIN Kai-lu;ZHU Hao-wei;HUANG Xiao-jing;XIE LU;L Liang(Emergency Medical Center,the Second Hospital of Yinzhou Distritc of Ningbo City,Ningbo,Zhejiang 315100,China)

机构地区：[1]宁波市鄞州区第二医院急救医学中心,浙江宁波315100

出　　处：《临床骨科杂志》2023年第4期461-465,共5页Journal of Clinical Orthopaedics

摘　　要：目的探讨肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗胸腰椎骨折的疗效。方法采用肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗28例胸腰椎骨折患者。记录手术时间、术中出血量、并发症发生情况、疼痛VAS评分、后凸Cobb角、伤椎前缘及中柱高度百分比。采用改良MacNab标准评价临床疗效。结果患者均获得随访,时间12~36(19.2±4.2)个月。手术时间105~180(143.8±24.3)min,术中出血量80~150(103.1±20.3)ml。术后无脊髓神经功能损害及椎弓根螺钉松动、移位、断裂等并发症发生,无“蛋壳椎”形成。疼痛VAS评分、后凸Cobb角、伤椎前缘及中柱高度百分比:术后3 d、12个月均明显优于术前(P<0.05),术后12个月与术后3 d比较差异均无统计学意义(P>0.05)。末次随访时采用改良MacNab标准评价临床疗效:优24例,良3例,可1例,优良率为27/28。结论采用肌间隙入路短节段椎弓根钉棒固定并经伤椎椎弓根植骨治疗胸腰椎骨折,具有创伤小、出血量少、患者可早期康复锻炼及改善腰背部疼痛等优点,且能有效恢复并维持椎体高度,增加椎体前缘、中柱的稳定性,减少后凸角的丢失和降低内固定物失败率。Objective To investigate the effect of short segmental pedicle screw-rod fixation combined with bone grafting through the fractured vertebral pedicle in the treatment of thoracolumbar fractures via Wiltse approach.Methods The 28 patients with thoracolumbar fractures were treated with short segmental pedicle screw-rod fixation and bone grafting through the fractured vertebral pedicle via Wiltse approach.The operative time,intraoperative bleeding volume,postoperative complications,pain VAS,the kythotic Cobb,the percentage of the fractured vertebral anterior edge height and the percentage of the fractured vertebral central height were recorded.The modified MacNab scoring criterion was used to evaluate the clinical efficacy.Results All patients were followed up for 12~36(19.2±4.2)months.The operation time was 105~180(143.8±24.3)min,and the intraoperative bleeding volume was 80~150(103.1±20.3)ml.There were no complications such as spinal cord nerve function damage,loosening,displacement,fracture of the pedicle screw,no eggshell vertebrae were formed.Pain VAS,kyphotic Cobb angle,the percentage of anterior edge and central column height of fractured vertebrae:at 3 d,12 months after operation,they were significantly better than those before operation(P<0.05),but there was no significant difference between 12 months and 3 d after operation(P>0.05).At the last follow-up,the modified MacNab criterion were used to evaluate the clinical effect assessed:24 cases were excellent,3 cases good,1 fair,and the excellent-good rate was 27/28.Conclusions For the treatment of thoracolumbar fractures,the short segmental pedicle screw-rod fixation combined with bone grafting through the fractured vertebral pedicle via Wiltse approach has the advantages of less trauma,less bleeding,early rehabilitation exercise for patients and improvement of low back pain,and the patients can effectively restore and maintain the height of the vertebrae,increase the stability of the vertebral anterior edge and the central column,reduce the loss of kypho

关 键 词：胸腰椎骨折 伤椎 植骨 固定 椎旁入路 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]