MAST Quadrant通道下椎旁肌间隙入路经伤椎椎弓根植骨治疗胸腰椎爆裂骨折

目的:观察在MAST Quadrant通道辅助下由椎旁肌间隙入路经伤椎椎弓根向椎体植骨短节段钉棒内固定术治疗胸腰椎爆裂骨折的临床疗效。方法:回顾性分析2009年6月至2012年9月资料完整并得到随访的胸或腰椎单节段爆裂骨折患者42例,男19例,女23例,年龄(55.2±11.9)岁,受伤时间(5.8±4.3)d。骨折节段:T103例,T116例,T1213例,L19例,L27例,L34例。骨折Denis分型:A型9例,B型21例,C型5例,D型5例,E型2例。所有患者采用MAST Quadrant通道辅助下由椎旁肌间隙入路经伤椎椎弓根向椎体植骨短节段钉棒内固定治疗,对患者手术时间、出血量、并发症进行观察,并对手术前后的伤椎椎体前缘高度、后凸Cobb角、VAS疼痛评分及下腰痛JOA评分进行比较。结果:术后1周椎体前缘高度、后凸Cobb角、VAS评分与术前比较差异均有统计学意义,与术后1年比较差异无统计学意义。术后1周伤椎椎体高度恢复率(95.23±3.18)%,术后1年(94.15±2.73)%,两者比较差异无统计学意义。术后1周JOA评分与术前比较差异有统计学意义,术后1年与术后1周比较差异也有统计学意义。结论:采用MAST Quadrant通道辅助下由椎旁肌间隙入路经伤椎椎弓根向椎体植骨短节段钉棒内固定术治疗胸腰椎爆裂骨折是一种安全、微创、疗效满意的治疗方法。

Internal fixation combined with bone grafting through the injured pedicle for the treatment of thoracolumbar burst fractures via a paraspinal intermuscular approach under MAST Quadrant retractor

Objective: To study clinical effects of short segment fixation and injured vertebra bone grafting through injured pedicle for the treatment of thoracolumbar burst fractures under MAST Quadrant retractor via a paraspinal muscle approach. Methods: The data of 42 patients with thoracolumbar burst fractures treated from June 2009 to September 2012 were reviewed. There were 19 males and 23 females,with an average age of (55.2±11.9) years old. The mean injury time was (5.8±4.3) days. Fracture segments included T₁₀ in 3 cases,T₁₁ in 6 cases,T₁₂ in 13 cases,L₁ in 9 cases,L₂ in 7 cases,and L₃ in 4 cases. According to Denis classification,9 patients were type A,21 patients were type B,5 patiens were type C,5 patients were type D,and 2 patients were type E. All the patients were treated with short segment pedicle screw rod system fixation under MAST Quadrant via the paraspinal muscle approach. The operative time,blood loss,complications and the height of vertebra,kyphosis Cobb angle,VAS scores,JOA scores were measured before and after treatment. Results: After treatment,the vertebral height and kyphosis Cobb angle were restored. Compared with preoperative results,postoperative vertebral height and kyphosis Cobb angle,VAS scores and JOA scores were all improved. But there was no statistically significance in vertebral height,kyphosis Cobb angle between postoperative at 1 week and 1 year. Conclusion: Internal fixation combined with injured vertebra bone grafting through the injured pedicle for the treatment of thoracolumbar burst fractures via the paraspinal intermuscular approach under MAST Quadrant is a safe,minimally invasive,effective and satisfactory method.