经皮椎弓根螺钉固定联合有限切开减压治疗胸腰段爆裂骨折伴神经功能损伤

目的:评价经皮椎弓根螺钉固定联合后路有限切开减压治疗胸腰段爆裂骨折伴神经功能损伤的疗效。方法:回顾性分析2010年6月至2014年6月76例具有完整资料的采用经皮椎弓根螺钉固定联合后路有限切开、椎管扩大减压治疗的胸腰段爆裂骨折伴神经功能损伤的患者,其中男45例,女31例;年龄17~56岁,平均32.5岁。根据Denis爆裂骨折分型,A型33例,B型26例,C型17例。神经功能损伤参照ASIA分级,A级13例,B级9例,C级21例,D级33例。记录手术时间、术中出血量、术后内固定松动断裂情况,比较术前、术后3 d及末次随访时矢状面Cobb角及椎管内占位变化,分析末次随访时神经功能改善情况。结果:76例患者手术时间136~218 min,平均159 min;术中出血量150~360 ml,平均225 ml。所有患者获得随访,时间13~47个月,平均32.1个月。术前、术后3 d及末次随访时伤椎前缘高度分别为(52.0±5.9)%、(87.2±1.8)%和(86.1±1.5)%,差异有统计学意义(F=45.27,P=0.000);矢状面Cobb角分别为(29.7±8.2)°、(5.7±2.9)°和(5.9±3.6)°,差异有统计学意义(F=34.62,P=0.000);椎管内占位率分别为(37.5±7.2)%、(12.3±3.3)%和(11.9±3.1)%,差异有统计学意义(F=37.02,P=0.000);以上指标末次随访与术后3 d比较均未见明显丢失(P0.05)。末次随访神经功能ASIA分级,A级13例,B级0例,C级10例,D级21例,E级32例。2例患者出现术后内固定松动、断裂。结论 :经皮椎弓根螺钉固定联合后路有限切开减压治疗胸腰段爆裂骨折伴神经功能损伤能够取得满意的疗效,术后神经功能恢复良好。

Percutaneous pedicle screw fixation combined with limited-open decompression technique for thoracolumbar fractures with neurologic deficit

Objective:To evaluate the clinical effects of percutaneous pedicle screw fixation combined with limited open decompression technique for the treatment of thoracolumbar fractures with neurologic deficit.Methods:The clinical data of 76 patients with thoracolumbar fractures with neurologic deficit underwent percutaneous pedicle screw fixation combined with limited open decompression technique from June 2010 to June 2014 were retrospectively analyzed. There were 45 males and 31 femals,aged from 17 to 56 years with an average of 32.5 years old. According to the classification of Denis,33 cases were type A,26 cases were type B,17 cases were type C. According to the criterion of American Spinal Injury Association(ASIA),13 cases were grade A,9 cases were grade B,21 cases were grade C,33 cases were grade D. The operative time,intraoperative blood loss,postoperative internal fixation lossening and breakage were recorded. The informations of the Cobb angle,the anterior height of injured vertebra,canal stenosis were observed before operation,3 days after operation,and the final follow-up. The improvement of neurologic function were analyzed at final follow-up.Results:All the patients were followed up from 13 to 47 months with an average of 32.1 months. The mean operative time was 159 min (136 to 218 min) and the intraoperative blood loss was 225 ml(150 to 360 ml). The anterior height of injured vertebra was increased from (52.0±5.9)% before operation to (87.2±1.8)% at 3 days after operation,and (86.1±1.5)% at final follow-up (F=45.27,P=0.000);the Cobb angle was decreased from (29.7±8.2)° before operation to (5.7±2.9)° at 3 days after operation,and (5.9±3.6)° at final follow-up (F=34.62,P=0.000);the canal stenosis was decreased from (37.5±7.2)% before operation to (12.3±3.3)% at 3 days after operation,and (11.9±3.1)% at final follow-up(F=37.02,P=0.000); there was no significant differences between postoperative 3 days and the final follow-up about the above parametres(P>0.05). According to ASIA criterion,the spinal cord function was classified as grade A in 13 cases,grade B in 0 cases,grade C in 10 cases,grade D in 21 cases and grade E in 32 cases at final follow-up. Internal fixation lossening and breakage occurred in 2 cases.Conclusion:Percutaneous pedicle screw fixation combined with limited open decompression technique can obtain satisfactory clinical effect for patients with thoracolumbar fractures with neurologic deficit,and have a good recovery of nerve function can be observed.