经皮微创相邻节段弓根钉植入治疗单节段胸腰椎脊柱骨折

目的探讨经皮微创短节段弓根钉植入治疗单节段胸腰段脊柱骨折的可行性。方法 2007年5月～2009年2月,对17例单节段胸腰椎骨折(T126例,L19例,L22例)采用经皮微创弓根钉经伤椎和上位相邻椎体撑开复位固定。全麻后进行有效对抗牵引复位,利用C形臂X线透视机定位弓根钉进钉点并经皮小切口旋入弓根钉,然后在髂嵴肌深层潜行安装尾杆固定。术后2周、3个月、6个月测量伤椎椎体前高、Cobb氏角,拔钉时按Denis疼痛分级进行效果评定。结果 17例伤椎椎体前缘高度及其Cobb氏角丢失存在,且以3例爆裂性骨折为明显(椎体高度80%～85%,Cobb氏角15°～28°),伤椎椎体前缘高度术前(68.8±10.5)%,显著低于术后2周(98.2±1.5)%、3个月(95.0±2.5)%、6个月(85.0±4.7)%(q=20.429,P0.05;q=18.205,P0.05;q=11.882,P0.05)。伤椎Cobb氏角术前21.7°±5.1°,显著大于术后2周5.2°±1.0°、术后3个月7.9°±2.0°、术后6个月10.4°±2.6°(q=22.139,P0.05;q=18.517,P0.05;q=15.162,P0.05)。17例疼痛评分均在P2以下,内固定材料无松动、断裂。结论经皮短节段弓根钉技术是治疗单节段胸腰椎简单骨折的有效方法,但要严格掌握适应证。

Percutaneous Short-segment Pedicle Screw Fixation for the Treatment of Single Thoracolumbar Vertebra Fracture

Objective To evaluate the feasibility of percutaneous short-segment pedicle screw（PSPS）fixation for patients with single thoracolumbar vertebra fractures.Methods From May 2007 to February 2009,17 patients with single thoracolumbar vertebrae fracture,including six cases at the T12,9 at the L1 and 2 at the L2,were treated in our hospital by PSPS fixation.Under general anesthesia,traction reduction was performed,and then under the guidance of C-arm X-ray,the fixation was carried out into the deep iliac muscles.At 2 weeks,3 months,and 6 months after the operation,the height of the injured vertebra,Cobb angle,and Denis Pain scale were measured to determine the surgical outcomes.Results The loss of frontier height of the injured vertebra and Cobb angle were detected in all of the 17 patients,among whom,the vertebral height achieved a 80%-85% restoration,and Cobb angle 15°-28° in the 3 patients who had explosive fracture.The mean height of the frontier vertebra was（68.8±10.5）% of the original height before the operation,which was improved significantly after the operation at 2 weeks [（98.2±1.5）%,q=20.429,P〈0.05],3 months [（95.0±2.5）%,q=18.205,P〈0.05],and 6 months [（85.0±4.7）%,q=11.882,P〈0.05].Meanwhile,the Cobb angle of the fractured vertebrae decreased significantly after the treatment [21.7°±5.1° vs.5.2°±1.0° at 2 weeks（q=22.139,P〈0.05）,7.9°±2.0° at 3 months（q=18.517,P〈0.05）,and 10.4°±2.6° at 6 months（q=15.162,P〈0.05）].The Denis pain scale showed P2 in all of the patients.No patient had loosened or broken fixation.Conclusions PSPS fixation is an effective treatment for simple single thoracolumbar vertebra fracture.Strict indication is the key to this procedure.