经椎旁肌间隙入路钉棒系统内固定治疗胸腰椎骨折

目的探讨后路经椎旁肌间隙椎弓根螺钉棒系统治疗无神经症状胸腰椎骨折的临床疗效。方法对27例无神经症状的胸腰椎骨折患者,采用后路经肌间隙入路椎弓根螺钉棒系统撑开复位内固定治疗,观察手术时间、术中出血情况及术前、术后椎体前缘高度、后凸Cobb角及腰椎疼痛恢复情况。结果手术时间55～110 min,平均75.8 min。术中出血量100～200 ml,平均120 ml。术后随访12～16个月,平均13.5个月。末次随访椎体前缘高度恢复至（90.2±4.6）%,后凸Cobb角矫正至（5.7±1.6）°,VAS评分（1.9±0.8）分,较术前差异有统计学意义（P〈0.01）。所有病例未发现神经损伤、内固定失效及腰背部疼痛及腰椎失能。结论后路经椎旁肌间隙椎弓根螺钉棒系统治疗无神经症状胸腰椎骨折可有效保留脊柱后方肌肉复合体结构,具有创伤小、出血少和降低术后腰背痛和腰椎失能发生率的优点。

Surgical treatment of thoracolumbar fractures with pedicle screw and rod fixation system through paraspinal approach

Objective To investigate the clinical effects of surgical treatment of thoracolumbar fractures with pedicle screw and rod fixation system through the paraspinal approach. Methods From September 2010 to December 2012, 27 cases of non-neurological symptoms patients with thoracolumbar fractures were treated with posterior pedicle screw and rod system by distraction reduction and internal fixation through the paraspinal approach. The operation time, blood loss, the height of the anterior border and the Cobb＇s angle restoration and pain visual analog scale（VAS） score between the preoperative and postoperative were observed. Results Median operating time was 74.2 min（range 50～96 min） and median blood loss was l20 ml（range 100～200 ml）. Average follow-up time was 13.5 months（range 12～16 months）. At the latest follow-up, the height of the anterior border was corrected to（90.2±4.6）%, the Cobb＇s angle was（5.7±1.6）° and VAS was（1.9±0.8）. Compared with preoperation, the differences were significant（P〈0.01）. There were no instances of nerve injury, instrumentation failure and no patient had persistent postoperative chronic back pain and disability. Conclusion The treatment of thoracolumbar fractures with pedicle screw and rod fixation system through the paraspinal approach can retainthe posterior ligament complex, has the advantages of less invasive, blood loss and decreases the risks of postoperative chronic back pain and disability.