微创三节段经皮椎弓根螺钉内固定选择性治疗胸腰椎骨折

目的 评价微创三节段经皮椎弓根螺钉内固定术治疗胸腰椎骨折的效果.方法 选择2008年6月至2009年3月在我科住院治疗的为42例胸腰椎骨折无神经功能损害患者分为三节段经皮椎弓根螺钉内固定微创手术组[共16例,男性11例,女性5例,年龄(40.2±8.6)岁]和开放手术组[共26例,男性17例,女性9例,年龄(42.4±9.3)岁],对比分析手术切口、手术时间、H{血量以及后凸畸形矫正率等.结果 与开放手术组相比,微创手术组手术切口明显缩小[(16.5±1.8)、(10.1±1.0)cm,P<0.05],术中出血量[(346.2±138.7)、(81.3±21.9)ml,P<0.01]及术后引流量[(138.6±46.5)、(13.7±4.3)ml,P<0.01]均明显减少,手术时间明显缩短[(2.5±0.7)、(1.2±0.6)h,P<0.05].微创手术组手术前后Cobb's角[(15.4±5.1)°、(3.8±2.8)°,P<0.01]、椎体矢状面指数[(19.7±10.3)°、(7.3±9.1)°,P<0.01]和伤椎椎体前缘高度[(63.2±14.6)%、(86.4±6.9)%,P<0.01]均显著恢复.结论 在严格掌握照手术适应证的前提下,微创三节段经皮椎弓根螺钉内固定术是治疗胸腰椎骨折的较好选择.

Application of mini-invasive percutaneous pedicle screw fixation in thoracolumbar fracture using multi-level Sextant system

Objective To assess the therapeutic effect of mini-invasive percutaneous pedicle screw fixation in thoracolumbar fracture using multi-level Sextant system. Methods From June 2008 to March 2009, 42 tho-racolumbar fracture patients in our department were selected. They were divided into 2 groups: 16 cases (11 males and 5 females, age 40.2±8.6) were included in the multi-level Sextant percutaneous pedicle screw fixa-tion group and 26 eases (17 males and 9 females, age 42.4±9.3) were in the open pedicle screw fixation group. The incision size, surgical time, surgical blood loss, correction rate of kyphosis of the 2 groups were compared. Results Compared with the open pedicle screw fixation group, patients in the multi-level Sextant percutaneous pediele screw fixation group experienced a significantly smaller incision size(16.5±1.8 cm vs 10.1±1.0 cm, P<0.05), a significant decrease in surgical blood loss (346.2±138.7 ml vs 81.3±21.9 ml,P <0.01) and surgical draining loss (138.6±46.5 ml vs 13.7±4.3 ml, P <0.01). Surgical time shortened significantly (2.5±0.7 h vs 1.2±0.6 h, P < 0.05). There were significant postoperative improvement in Cobb's angle [(15.4±5.1)°vs (3.8±2.8)°, P<0.01], sagittal index [(19.7±10.3)°vs (7.3±9.1)°, P < 0.01] and anterior height [(63.2±14.6) % vs (86.4±6.9) %, P <0.01] of fracture verte-bral body in the multi-level Sextant percutaneous pedicle screw fixation group. Conclusion With a good com-mand of the surgical indications, mini-invasive percutaneous pedicle screw fixation using multi-level Sextant system is a good therapeutic choice for patients with thoracolumbar fracture.