斜外侧入路椎间融合术治疗胸腰椎骨折术后内固定失败的初步疗效分析  

Oblique intervertebral fusion for treatment of failed internal fixation of thoracolumbar fractures

作　　者：周威威 任志楠 于磊[1] 朱广铎 宋鑫 连续 镐英杰[1] Zhou Weiwei;Ren Zhinan;Yu Lei;Zhu Guangduo;Song Xin;Lian Xu;Hao Yingjie(Department of Orthopedics,The First Hospital Affiliated to Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院骨科,郑州450052

出　　处：《中华创伤骨科杂志》2023年第7期595-600,共6页Chinese Journal of Orthopaedic Trauma

基　　金：河南省科技攻关计划项目(202102310137)。

摘　　要：目的探讨斜外侧入路椎间融合术治疗胸腰椎骨折术后内固定失败的疗效。方法回顾性分析2014年1月至2021年12月郑州大学第一附属医院骨科因胸腰椎骨折术后内固定失败进行翻修手术的14例患者资料。男6例,女8例;年龄47.5(42.0,54.3)岁;骨折节段:T122例,L13例,L24例,L33例,L42例;根据AO胸腰椎损伤分类系统分类:A型1例,B型7例,C型6例。既往采用后路椎弓根螺钉内固定术。翻修均采用后路内固定重置后行斜外侧入路椎体次全切除、骨柱重建、侧方钉棒内固定椎间融合术。记录患者的手术时间、术中出血量、术后住院时间、并发症发生情况,比较患者术前、术后3 d、3个月、末次随访时腰腿痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)以及末次随访时融合情况,比较手术前、后神经功能的Frankel分级。结果所有患者手术均顺利完成。14例患者均获随访,时间23(18,24)个月。手术时间(175.1±28.2)min,术中出血量(300.4±122.6)mL,术后住院时间6(6,7)d。1例术后出现一过性屈髋无力,给予保守治疗恢复至正常肌力后出院。所有患者术后3 d、术后3个月、末次随访时腰腿痛VAS评分和ODI均较术前显著改善,差异均有统计学意义(P<0.05);且术后3 d>术后3个月>末次随访时,差异均有统计学意义(P<0.05)。术前12例有神经损害的患者,术后Frankel分级至少上升1级,与术前比较差异有统计学意义(Z=-3.110,P=0.002)。末次随访时均未见内固定松动、断裂现象,CT矢状位重建全部可见骨性融合。结论对于单节段胸腰椎骨折术后内固定失败的患者,斜外侧入路椎间融合术是一种可选择的微创手术方式,疗效满意。Objective To investigate the clinical efficacy of oblique intervertebral fusion in the treatment of failed internal fixation of thoracolumbar fractures.Methods A retrospective study was conducted to analyze the clinical data of 14 patients who had undergone revision surgery for failed internal fixation of thoracolumbar fracture at Department of Orthopedics,The First Hospital Affiliated to Zhengzhou University from January 2014 to December 2021.There were 6 men and 8 women with a mean age of 47.5(42.0,54.3)years.Fracture segments:T12 in 2 cases,L1 in 3 cases,L2 in 4 cases,L3 in 3 cases,and L4 in 2 cases;AO classification:type A in 1 case,type B in 7 cases,and type C in 6 cases.Their prior surgical method was posterior internal fixation with pedicle screws.The revision surgery consisted of subtotal vertebral resection through the oblique lateral approach,bone column reconstruction and lateral screw-rod internal fixation for intervertebral fusion after posterior internal fixation reset.The operation time,intraoperative bleeding,postoperative hospital stay,and incidence of complications were recorded.Compared were visual analogue scale(VAS)and Oswestry disability index(ODI)scores for low back pain at preoperation,3 days and 3 months postoperation,and the last follow-up,fusion at the last follow-up,and Frankel grading for neurological function at preoperation and postoperation.Results All the 14 patients underwent surgery successfully and were followed up for 23(18,24)months.The operation time was(175.1±28.2)min,the intraoperative bleeding(300.4±122.6)mL,and the postoperative hospital stay 6(6,7)d.One case developed postoperative transient hip flexion weakness but was discharged after restoration of normal muscle strength by conservative treatment.Both VAS and ODI scores for low back pain at all postoperative time points were significantly improved compared with the preoperative values(P<0.05),with a significant trend of 3 days postoperation>3 months postoperation>the last follow-up(P<0.05).In the 12 patients with p

关 键 词：胸椎 腰椎 骨折固定术 内 斜外侧入路手术 翻修 

分 类 号：R687.3[医药卫生—骨科学]