经皮椎弓根螺钉内固定结合椎体内植骨治疗胸腰椎骨折

 目的 探讨经皮椎弓根螺钉结合椎体内植骨治疗胸腰椎骨折的有效性。方法 采用 Sextant微创脊柱系统结合椎体内植骨技术治疗无神经功能损害、载荷分享评分逸7分的胸腰椎 A型骨折患者 20例, 并与同期行开放椎弓根螺钉内固定结合椎体内植骨治疗的 20例患者进行比较, 观察两组间的临床及影像学各项指标。结果 两组患者间性别、年龄、手术时机及载荷分享评分差异无统计学意义；但手术时间及出血量经皮组明显小于开放组(P约 0.05)。两组患者术后椎体前高、后凸角均显著恢复(P<0.05)；术后 1年, 两组均见椎体前高和后凸角的显著丢失(P约 0.05)；末次随访, 两组也均未见上述指标的进一步丢失。影像学指标与临床疗效两组间差异无统计学意义, 经皮组影像学指标恢复略差, 但临床疗效略优。结论 (1)经椎弓根椎体内植骨技术可应用于治疗载荷分享评分逸7分、无神经功能损害的胸腰椎爆裂骨折；(2)尽管经皮椎弓根螺钉内固定术的影像学各指标略差于开放组, 但由于其损伤小、出血少等优点, 仍获得较好的临床疗效。

Percutaneous pedicle screw fixation combined with transpedicular interbody bone grafting for the treatment of thoracolumbar fractures

Objective To investigate the efficacy of percutaneous pedicle screw fixation combined with transpedicular interbody bone grafting for the treatment of thoracolumbar fractures.Methods A total of 20 patients with thoracolumbar fractures (type A,load sharing ≥7,without neurological deficit) underwent percutaneous pedicle screw fixation of Sextant systems combined with transpedicular interbody bone grafting were retrospectively studied.The perioperative parameters,radiographic and clinical outcomes were compared with another 20 patients underwent traditional short-segment pedicle screw fixation combined with transpedicular interbody bone grafting.All patients were followed up for at least 2 years after surgery.Results There were no significant differences between the two groups in sex,age,injury to operation interval,and load sharing scores.However,there were significant differences between the two groups in operating time and blood loss (P＜0.05).The vertebral body height and kyphosis angle were corrected significantly after surgery (P＜O.05),however,the recovery of the vertebral body height and kypbosis angle were reduced significantly one year after surgery in both groups (P＜0.05).At the final follow-up,there were no significant progressive losses of the recovery of the vertebral body height and kyphosis angle,as compared with that of one year after surgery in two groups.There were no significant differences in radiographic parameters and the clinical outcomes between the two groups,even though less radiographic correction and better clinical outcomes were found in percutaneous techniques.Conclusion Short-segment pedicle screw fixation with transpedicular grafting remains a reliable surgical method for the treatment of severe thoracolumbar fractures without neurological deficit.Percutaneous pedicle screw fixation proved to be an effective method with the advantages of minimal invasiveness and less blood loss.