微雕关节突关节经椎间孔复位椎管内骨块减压术治疗胸腰椎爆裂骨折的疗效分析  

Analysis of the curative efficacy of intraspinal bone decompression by micro-sculpture facet joint transforaminal reduction through the intervertebral foramen in the treatment of thoracolumbar burst fractures

作　　者：廖仁可 吴波[1] 徐峰[1] 胡忠钦 何秦[2] LIAO Ren-ke;WU Bo;XU Feng;HU Zhong-qin;HE Qin(Department of Orthopedics,Xuanhan County People's Hospital,Xuanhan 636150,China;Department of Orthopedics,Dazhou Central Hospital,Dazhou 635099,China)

机构地区：[1]四川省宣汉县人民医院骨科,四川宣汉636150 [2]四川省达州市中心医院骨科,四川达州635099

出　　处：《实用医院临床杂志》2024年第5期184-188,共5页Practical Journal of Clinical Medicine

基　　金：四川省医学会骨科(尚安通)专项科研课题(编号:2021SAT17)。

摘　　要：目的探讨微雕关节突关节经椎间孔复位椎管内骨块减压术治疗胸腰椎爆裂骨折的临床效果。方法回顾性分析2016年2月至2023年2月四川省宣汉县人民医院骨科收治的伴有骨块压迫并导致神经症状的胸腰椎爆裂骨折患者64例。接受经肌间隙入路微雕关节突关节行椎体后缘直接减压复位治疗的32例患者为观察组,接受经椎板入路行患侧椎板切除间接减压治疗的32例患者为对照组。比较两组术中出血量、手术时间、截骨量;比较两组术前、术后治疗12个月伤椎Cobb角、伤椎体前缘高度比、功能障碍ODI指数、疼痛程度评分以及末次随访脊髓神经功能分级。结果观察组术中出血量、手术时间、截骨量明显小于对照组(P<0.05);术后12个月观察组伤椎Cobb角明显小于对照组,伤椎体前缘高度比值显著大于对照组,ODI指数、VAS评分明显低于对照组,脊髓神经功能分级显著优于对照组(P<0.05)。结论微雕关节突关节建立减压通道,较常规经椎板切开减压能显著减少出血和创伤,提高椎体稳定性,恢复椎体高度,缓解功能障碍,改善脊髓神经功能。Objective To investigate the clinical effect of intraspinal bone decompression by micro-sculpture facet joint transforaminal reduction through the intervertebral foramen in the treatment of thoracolumbar burst fractures.Methods A retrospective analysis of 64 patients with thoracolumbar burst fractures with bone mass compression resulting in neurological symptoms from February 2016 to February 2023 at the Department of Xuanhan County People’s Hospital was performed.Thirty-two patients who underwent direct decompression reduction of the posterior margin of the vertebral body by micro-sculpting facet joints through paraspinal muscle approach were included in an observation group.Another 32 patients who underwent indirect decompression through laminectomy via laminar approach were involved in a control group.Intraoperative blood loss,operative duration and amount of bone amputation were compared between the two groups.Cobb angle,height ratio of the anterior margin of the injured vertebra,ODI index of dysfunction,VAS score of pain degree and spinal nerve function grade before and after 12 months of treatment were compared between the two groups.Results The amount of blood loss,operation time and bone amputation in the observation group were significantly less or shorter than those in the control group(P<0.05).After 12 months of surgery,the Cobb angle of injured vertebra in the observation group was significantly lower than that in the control group.The height ratio of anterior margin of injured vertebra was significantly higher than that in the control group.The ODI index and the VAS score in the observation group were obviously lower than those in the control group.The spinal nerve function grade in the observation group was noticeably better than that in the control group.All differences were statistically significant(P<0.05).Conclusions Compared with conventional laminectomy decompression,micro-sculpted facet joints are used to establish the decompression channel.Thus,it can significantly reduce the bleeding and

关 键 词：脊柱爆裂性骨折 微雕关节突关节 经肌间隙入路 减压 

分 类 号：R683.2[医药卫生—骨科学]