单平面钉经皮伤椎短节段固定治疗胸腰椎骨折

目的探讨单平面钉经皮伤椎短节段固定治疗胸腰椎骨折的疗效。方法2015年5月-2017年8月,采用单平面钉经皮伤椎短节段固定治疗38例无神经症状的胸腰椎骨折患者。其中男22例,女16例;年龄25~52岁,平均32.5岁。骨折AO分型:A3型23例、A4型15例。骨折节段:T114例、T129例、L111例、L210例、L33例、L41例。骨折至手术时间3~7 d,平均4.5 d。手术前后采用疼痛视觉模拟评分(VAS)评估患者腰背痛程度;行腰椎正侧位X线片、CT三维重建及MRI检查,测量伤椎前缘高度比和矢状面Cobb角,评估伤椎高度及骨折区局部后凸恢复情况。结果38例患者均顺利完成手术,术中无硬膜囊、神经根、血管损伤等并发症发生。手术时间(56.2±3.7)min,术中出血量(42.3±3.5)mL。切口无红肿、渗出,均Ⅰ期愈合。所有患者均获随访,随访时间17~33个月,平均21.5个月。术后各时间点VAS评分均较术前显著改善(P<0.05),术后3个月和末次随访时较术后1周进一步改善(P<0.05);术后3个月和末次随访间比较差异无统计学意义(P>0.05)。随访期间均未出现内固定物松动、断裂及迟发性后凸畸形。术后各时间点患者伤椎前缘高度比和矢状面Cobb角均较术前明显改善(P<0.05),术后各时间点间比较差异均无统计学意义(P>0.05)。结论采用单平面钉经皮伤椎短节段固定治疗无神经症状的胸腰椎骨折,操作简便,可以较好恢复伤椎高度、矫正后凸畸形,避免远期后凸畸形发生。

Clinical research of percutaneous monoplanar screw internal fixation via injured vertebrae for thoracolumbar fracture

Objective To evaluate the effectiveness of percutaneous monoplanar screw internal fixation via injured vertebrae for treatment of thoracolumbar fracture.Methods Between May 2015 and August 2017,38 cases of thoracolumbar fractures without neurological symptom were treated with percutaneous monoplanar screw internal fixation via injured vertebrae.There were 22 males and 16 females,aged 25-52 years(mean,32.5 years).There were 23 cases of AO type A3 and 15 cases of AO type A4.The injured vertebrae located at T11 in 4 cases,T12 in 9 cases,L1 in 11 cases,L2 in 10 cases,L3 in 3 cases,and L4 in 1 case.The mean interval between injury and operation was 4.5 days(range,3-7 days).The pre-and post-operative degrees of lumbodorsal pain were estimated by the visual analogue scale(VAS)score.The X-ray film,CT three-dimensional reconstruction,and MRI were performed,and the ratio of anterior vertebral body height and sagittal Cobb angle were measured to assess the kyphosis of the fractured area.Results All operations in 38 patients successfully completed without complications such as dural sac,nerve root,or vascular injury.The operation time was(56.2±3.7)minutes and the intraoperative blood loss was(42.3±3.5)mL.All incisions healed by first intention without redness,swelling,or exudation.All patients were followed up 17-33 months,with an average of 21.5 months.The VAS score at each time point after operation significantly improved when compared with that before operation(P<0.05),and significantly improved at 3 months and last follow-up when compared with that at 1 week(P<0.05);there was no significant difference between 3 months and last follow-up(P>0.05).There was no internal fixator loosening,breakage,or delayed kyphosis in all patients.The ratio of anterior vertebral body height and sagittal Cobb angle significantly improved postoperatively(P<0.05),and no significant difference was found between the different time points after operation(P>0.05).Conclusion Percutaneous monoplanar screw internal fixation via injured vertebrae is an easy approach to treat thoracolumbar fracture without neurological symptom,which can effectively restore vertebral body height and correct kyphosis,and avoid long-term segmental kyphosis.