微创椎弓根螺钉治疗不稳定性胸腰椎骨折的疗效分析

[目的] 探讨微创椎弓根螺钉固定复位术治疗不稳定性胸腰椎骨折的临床疗效.[方法] 收集2011年1月至2013年10月西安交通大学第二附属医院和西安交通大学第一附属医院骨科采用微创经皮椎弓根螺钉固定复位技术诊治的无神经症状的不稳定性胸腰椎骨折患者37例.记录手术时间,出血量,观察手术前后椎体高度、Cobb's 角变化,并统计术后并发症.[结果] 37例均获得随访.手术时间为1.1(0.75~1.5)h;出血量20~100 (40.5±10)mL;术后随访时间10~36(19.8±5.6)个月.术后4周、术后1年与术前1 d VAS评分比较差异有统计学意义(P<0.05),疼痛明显减轻;治疗4周、治疗12个月椎体前缘高度百分比和后凸Cobb角明显高于治疗前,其差异均有统计学意义(P <0.05),但术后1个月与术后12个月比较差异无统计学意义(P>0.05).术中并发症3例(8.1%),均系椎弓根螺钉置入不正确穿破外壁,无硬脊膜破裂及血管损伤患者.随访无明显后凸畸形和高度丢失,骨折全部获得愈合.12个月随访时发现2例患者共3枚螺帽松动;椎弓根螺钉断裂2例(5.4%),其中l例见于术后6个月,1例见于术后12个月;术后24个月椎弓根螺钉退出1例(2.7%).[结论] 微创经皮椎弓根螺钉技术可最大程度地减少对病椎稳定性的破坏,既能到达稳定脊柱的目的,又可减小术中创伤.在严格掌握手术适应证的前提下,其将会作为一项基础技术广泛应用.

Clinical Analysis of Pedicle Screw by Minimally Invasive Techniques to Treat Unstable Thoracolumbar Fractures

[Objective]To investigate the clinical efficacy of the minimally invasive pedicle screw fixation for the treatment of unstable thoracolumbar fractures.[Methods]Thirty-seven patients of unstable thoracolumbar fracture without neurological symptoms from January 2011 to October 2012 were seen in the Departments of Orthopedics of the First and Second Hospitals of Xi'an Jiaotong University.There were 24 males and 13 females, aged 19 to 69 years (mean 31.8 ± 8.5 years).All cases were treated with minimally invasive percutaneous pedicle screw fixation techniques.The operation time, blood loss, vertebral height before and after surgery, Cobb's angle changes, and postoperative complications were collected and statistical analysis was conducted.[Results]The operation time was 1.1 (0.75 ~ 1.5) h, the bleeding volume was 20~100 (40.5±10) mL, and the follow-up time was 10~36 (19.8±5.6) months.There were significant differences in VAS scores four weeks and one year after operation compared to that on one day before operation (P<0.05), showing a significant reduction in pain.The percentage of vertebral body height and Cobb's angle were significantly higher than those before treatment, and the difference was statistically significant (P<0.05).The percentage of vertebral height and Cobb's angle before treatment and after treatment were significantly different (P<0.05).However, there were no statistical difference between these values one month and twelve months after surgery (P>0.05).Intraoperative complications accounted for three cases (8.1%), caused by improper pedicle screw placement resulting in piercing the outer wall, while there were no rupture of the dura mater and vascular injury patients.However, follow-up showed fracture healed without much deformity and height loss.The twelve-month follow-up had two patients with a total of three loose pedicle screws.There were two cases (5.4%) of ruptured pedicle screw;one case was seen six months after operation and another case was seen twelve months after operation.Only one case (2.7%) showed pedicle screw withdrawal twenty-four months after operation.[Conclusion]Minimally invasive percutaneous pedicle screw technology can minimize the damage on stability of the disease, not only to achieve the purpose of stabilizing the spine, but also to reduce intraoperative trauma.Under the premise of strict control of surgical indications, it can be widely used as a basic technology.