单侧双通道脊柱内镜技术结合经皮椎弓根螺钉内固定治疗腰椎爆裂性骨折疗效  

Effectiveness of unilateral biportal endoscopy technique combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures

作　　者：闫挺 曾俊[1] 吴超[1] 林旭[1] 胡海刚[1] 钟泽莅[1] YAN Ting;ZENG Jun;WU Chao;LIN Xu;HU Haigang;ZHONG Zeli(Department of Orthopedic Center,the Fourth People’s Hospital of Zigong,Zigong Sichuan,643000,P.R.China)

机构地区：[1]自贡市第四人民医院骨科中心,四川自贡643000

出　　处：《中国修复重建外科杂志》2024年第11期1372-1378,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：自贡市重点科技计划项目(2022ZCYGY15)。

摘　　要：目的对比单侧双通道脊柱内镜(unilateral biportal endoscopy,UBE)技术辅助椎管减压结合经皮椎弓根螺钉内固定与传统开放减压内固定治疗腰椎爆裂性骨折的疗效。方法回顾分析2022年10月—2023年12月收治且符合选择标准的61例单节段腰椎爆裂性骨折患者临床资料。其中25例采用UBE技术辅助椎管减压结合经皮椎弓根螺钉内固定治疗(UBE组),36例采用传统后路单侧半椎板开窗减压内固定治疗(开放组)。两组患者性别、年龄、身体质量指数、骨折节段、致伤原因、AO分型及术前伤椎前缘高度比、节段后凸角、椎管侵占率、美国脊柱损伤协会(ASIA)评分、疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)等基线资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量及术后并发症情况。术前、术后1周及末次随访时,采用VAS评分、ODI及ASIA分级评价临床疗效;行腰椎正侧位X线片及CT检查,测量节段后凸角、伤椎前缘高度比及椎管侵占率等影像学指标。结果两组患者均顺利完成手术,术中无硬膜囊、神经及血管损伤等并发症发生,术后切口均Ⅰ期愈合。两组手术时间比较差异无统计学意义(P>0.05);UBE组术中出血量少于开放组(P<0.05)。两组患者均获随访,随访时间6~20个月,平均13个月。随访期间均无内固定物松动、断裂及内固定失效等并发症发生。术后1周两组ASIA分级、VAS评分及ODI均较术前改善,且末次随访时进一步改善,差异均有统计学意义(P<0.05);术后1周及末次随访时,两组间ASIA分级比较差异无统计学意义(P>0.05),但UBE组VAS评分及ODI优于开放组(P<0.05)。术后1周两组伤椎前缘高度比、节段后凸角及椎管侵占率均较术前显著改善,末次随访时伤椎前缘高度比、节段后凸角较术后1周均有丢失,椎管侵占率则持续改善,差异均有统计学意义(P<0.05);术后两个时间点两�Objective To compare the effectiveness of unilateral biportal endoscopy(UBE)technique assisted spinal canal decompression combined with percutaneous pedicle screw internal fixation versus traditional open decompression and internal fixation for treatment of lumbar burst fractures.Methods A retrospective study was conducted on the clinical data of 61 patients with single-segment lumbar burst fractures who met the selection criteria and were admitted between October 2022 and December 2023.Of them,25 patients received UBE technique assisted decompression combined with percutaneous pedicle screw fixation(UBE group),while 36 patients were treated with traditional posterior unilateral hemilaminectomy decompression and internal fixation(open group).There was no significant difference in baseline data between the two groups(P>0.05),including gender,age,body mass index,racture segment,cause of injury,AO classification of lumbar fractures,and preoperative height ratio of the anterior margin of injured vertebra,segmental kyphosis angle,rate of spinal canal invasion,the classification of American Spinal Injury Association(ASIA)grading,visual analogue scale(VAS)score,and Oswestry disability index(ODI).The operation time,intraoperative blood loss,and postoperative complications were recorded and compared between the two groups.VAS score,ODI,and ASIA grading were used to evaluate the effectiveness before operation,at 1 week after operation,and at last follow-up.Lumbar anteroposterior and lateral X-ray films and CT were performed to measure the segmental kyphosis angle,height ratio of the anterior margin of injured vertebra,and the rate of spinal canal invasion.Results Sur-gery was successfully completed in both groups.No complication such as dural sac,nerve root,or vascular injury was found during operation,and all incisions healed by first intention.There was no significant difference in operation time between the two groups(P>0.05),the UBE group revealed significant less intraoperative blood loss when compared with open group

关 键 词：腰椎爆裂性骨折 单侧双通道脊柱内镜技术 椎管减压 经皮椎弓根螺钉 内固定 

分 类 号：R687.3[医药卫生—骨科学]