微创技术在不同类型胸腰段骨折中的应用

目的 探讨微创技术在胸腰段骨折的应用及疗效.方法 回顾性分析2005年2月至2010年6月采用微创手术治疗并有随访资料的胸腰段骨折患者共183例,男性126例,女性57例;年龄18～68岁,平均38.9岁.T11 22例,T12 61例,L1 71例,L2 29例.骨折按Gertzbein分型,A型145例,B型34例,C型4例;Load-sharing评分,4分51例,5分56例,6分17例,7分12例,8分24例,9分23例.根据微创手术策略选择不同的手术方法,采用经皮椎弓根螺钉内固定术( MIPPSO)治疗22例,小切口肌间隙椎弓根螺钉内固定术( SISPSO)治疗102例,胸腔镜或头灯光源辅助的小切口胸腰椎前路手术(SIATS)治疗31例,后路小切口270°减压重建术(270° DRS)治疗28例.Frankel 分级评定术后神经功能恢复情况,比较伤椎Cobb角的矫正和丢失及评估椎管减压范围及愈合情况.结果 183例患者均一期完成手术,术后随访12 ～60个月,平均35个月.MIPPSO治疗患者的手术时间为52～100 min,术中出血量为35～55 ml;SISPSO治疗患者的手术时间为48 ～ 68 min,术中出血量45～65 ml;两种术式治疗患者的Cobb角矫正8°～19°.SIATS手术治疗患者的手术时间为140～220 min,术中出血量160～1500 ml,术后X线检查显示脊柱序列和生理曲度基本恢复正常,Cobb角矫正15° ～25°;术后出现肺不张1例,股外侧皮神经损害1例,经治疗后症状消失.270° DRS治疗患者的手术时间为160 ～ 280 min,术中出血700～4700 ml,术后Cobb角矫正15° ～28°,1例术后神经症状加重.所有病例术后随访未发生内固定器松脱、移位及断裂,植骨均融合.所有椎管占位病例术后CT显示椎管腔扩大,减压彻底.除1例术后神经症状加重外,其余术前不完全性神经损伤患者术后神经功能Frankel分级均恢复1级或以上.结论 合理运用微创技术治疗胸腰段骨折效果满意.

The application of minimally invasive surgery for different type of thoracolumbar fractures

Objective To study the therapeutic method and effect of minimally invasive surgery for the thoracolumbar fractures.Methods A retrospective review of the minimally invasive surgically treatment thoracolumbar fractures from February 2005 to June 2010 was performed.There were 183 cases,126 males and 57 females,aged 18 to 68 years,average 38.9 years.The involved levels of fractures were T11 in 22,T12 in 61,L1 in 71,L2 in 29.According to Gertzbein classification,145 cases were type A fractures,34 cases were type B fractures,4 cases were type C fractures; According to Load-sharing score,51 cases were 4 scores,56 cases were 5 scores,17 cases were 6 scores,12 cases were 7 scores,24 cases were 8 scores,23 cases were 9 scores.Different surgical methods were selected according to the minimally invasive surgical strategy,22 patients were treated with the minimally invasive percutaneous pedicle screws osteosynthsis ( MIPPSO group),102 patients were treated with the small-incision pedicle screws osteosynthsis ( SISPSO group),31 patients were treated with the small incision anterior thoraciclumbar surgery (SIATS group )assisted by thoracoscope or headlight,and 28 patients were treated with the 270° decompression and reconstruction surgery (270° DRS group) via a posterior small incision.Preoperative and postoperative neurological status,the correction and loss of Cobb' s angle,the decompression scope of spinal canal,the location and union of bone graft were followed up and reviewed.Results All of 183 cases had successful surgery and were followed up.In the MIPPSO group,operative time was 52-100 min,blood loss was 35- 55 ml.In the the SISPSO group,operative time was 48-68 min,the blood loss was 45-65 ml the correction of Cobb's angle in the two groups was 8°-19°.In the SLATS group,operative time was 140-220 min,the blood loss was 160-1500 ml the correction of Cobb's angle was 15°-25°,1 case had pleural effusion,1 had lateral femoral cutaneous nerve damage,the complications disappeared after treatment.In the 270° DRS group the operative time was 160-280 min,the blood loss was 700-4700 ml,the correction of Cobb's angle was 15°-28°.The spinal canal mass was removed,the spinal canal was enlarged and completely decompressed.Neurological status improved in all of the preoperative incomplete paraplegia patients except 1 case whose neurological symptoms aggravated.Conclusion It is satisfactory that the minimally invasive surgical strategy was rational used in the treatment of thoracolumbar fractures.