经皮椎弓根螺钉固定治疗无神经损伤胸腰椎骨折

目的 评价经皮椎弓根螺钉固定治疗无神经损伤胸腰椎骨折的安全性及有效性.方法选择2007年1月-2007年12月无神经损伤胸腰椎创伤性骨折患者15例,均于伤后10 d内手术,其中男10例,女5例;年龄31～65岁,平均45.6岁.骨折部位:T<,11>骨折1例,T<,12>骨折4例,L1骨折7例,L2骨折2例,L3骨折1例.术前进行脊柱正、侧位摄片、CT和MRI检查,评价椎体、椎管、椎间盘及韧带损伤情况.根据脊柱骨折Magerl分型:A3型骨折10例,A2型骨折3例,A1型骨折2例,进行经皮椎弓根螺钉固定治疗.记录手术时间和术中失血量,随访观察治疗效果,进行回顾性分析.结果 手术时间65～110 min,平均82 min.术中失血20～50 ml,平均35 ml.无转为开放手术患者,无神经损伤或其他并发症.随访3～11个月,平均7.6个月.Cobb角由术前(15.7±6.3).减少为术后(3.5±1.2)..CT检查显示与术前比较椎体后缘骨块复位良好.结论经皮椎弓根螺钉固定是治疗无神经损伤胸腰椎骨折安全有效的手术方法,与开放手术比较具有组织损伤轻、出血少和恢复快等优点.

Percutaneous pedicle screw fixation for traumatic thoracolumbar fracture without neurologic deficits

Objective To evaluate the feasibility and safety of percutaneous posterior pedicle screw fixation in treatment of traumatic thoracolumbar fracture without neurologie deficits. Methods From January 2007 through December 2007, there were 15 patients with traumatic fracture of the thoracic or lumbar spine without neurologie deficits treated within 10 days after injury. There were 10 males and 5 females at age range of 31-65 years (average 45.6 years). The fracture was located at T11 in 1, T12 in 4,L1 in 7, L2 in 2 and L3 in 1. Preoperative anteroposterior and lateral radiographs of the fractured spine as well as CT and MRI were done to evaluate injury severity of the vertebral body, spinal canal and diseolig-amentary structures. According to Magerl classification criteria, there were 10 patients with type A3 frac-ture, 3 with type A2 fracture and 2 with type A1 fracture, which were treated with pereutaneous posterior pediele screw fixation. Operative time and intraoperative blood loss were recorded to observe clinical re-suits. Results The average operation time was 82 minutes (65-110 minutes), with a mean intraopera-five blood loss of 35 ml (20-50 ml ). There were no conversions to open surgery, new neurological deficits or other surgery-related complications. All patients were followed up for 3-11 months (average 7.6 months), which showed that Cobb angle was corrected from preoperative (15.7±6.3)° to postoperative (3.5±1.2)°. Postoperative CT showed sound reduction of posterior bone displacement in all patients compared to preoperative CT results. Conclusions Percutaneous posterior pedicle screw fixation is fea-sible and safe surgical procedure with fine short-term outcome in treating traumatic thoracolumbar fracture without neurologic deficits. This technique offers serveral potential advantages over open approaches inclu-ding less tissue trauma and blood loss as well as quicker recovery.