经皮椎弓根螺钉内固定治疗胸腰椎骨折的临床观察

目的观察采用微创切口经椎旁肌间隙入路使用长臂万向椎弓根螺钉内固定技术治疗无脊髓/神经损伤的单个胸腰椎椎体骨折的临床疗效。方法选择2011年6月~2015年5月成都医学院第一附属医院的60例符合入选标准的患者,分为微创实验组和传统对照组,每组30例。微创实验组选用经椎旁肌间隙(最长肌和多裂肌间隙)入路,并使用长臂万向椎弓根螺钉撑开复位固定无脊髓/神经损伤的单个胸腰段骨折;传统对照组采用传统正中切口手术,比较两组伤椎椎体高度恢复百分比、伤椎Cobb's角恢复百分比、手术时间、住院时间、术中出血量、术后伤口引流量及术中透视次数。结果两组病例通过术后复查X线片,微创实验组和传统对照组的伤椎椎体高度恢复百分比分别为(48.0±9.5)%、(50.2±9.4)%,微创实验组和传统对照组的伤椎椎体Cobb's角恢复百分比分别为(78.8±10.8)%、(80.2±8.9)%,上述两指标经比较无显著差异(P0.05)。但微创实验组和传统对照组的手术时间分别为(68.4±11.5)min、(131.2±45.1)min,住院时间分别为(12.7±2.4)d、(20.5±5.3)d,术中出血量分别为(41.2±12.5)m L、(227.6±56.4)m L,术后伤口的引流量分别为(31.9±10.4)m L、(247.4±48.4)m L,术中需要透视的次数分别为(4.0±0.5)次、(7.5±2.0)次,微创实验组均优于传统对照组(P0.05)。结论微创切口经椎旁肌间隙入路技术不但可有效恢复椎体高度及脊柱生理曲度,而且具有术中创伤小、围手术期出血少、术后恢复快等优点,对无脊髓/神经损伤的单个胸腰椎椎体骨折是一种实用的外科手术技术,值得临床推广。

Clinical observation of percutaneous pedicle screw fixation for thoracolumbar fractures

Objective To observe the clinical efficacy of minimally invasive incision therapy for single thoracolumbar fractures without spinal cord/nerve injury by long arm universal pedicle screw internal fixation technique through paraspinal muscle gap approach.Methods Totally 60 up-to-standard patients from Jun.2011 to May 2015 were selected and divided to 2 groups.The observation group (n=30) used the minimally invasive incision therapy for single thoracolumbar fractures without spinal cord/nerve injury by long arm universal pedicle screw internal fixation technique through paraspinal muscle gap approach.The control group (n=30) used traditional median incision.Height recovery of the injured vertebra,recovery of the Cobb's angle,operation time,hospitalization time,operative blood loss,postoperative drainage volume and exposure times were compared between the two groups.Results The postoperative X-ray of the two groups showed that the vertebral body height recovery percentage was (48.0±9.5)% and (50.2±9.4)%,respectively.The Cobb's angle recovery percentage was (78.8±10.8)% and (80.2±8.9)%,respectively.There was no difference between the two groups in the above two indexes(P>0.05).But the operation time was (68.4±11.5) and (131.2±45.1) min,respectively,and the hospitalization time was (12.7±2.4) and (20.5±5.3) days,respectively.The blood loss during the operation were (41.2±12.5) and (227.6±56.4)mL,the postoperative wound drainage were (31.9±10.4) and (247.4±48.4)mL,and the intraoperative X-ray exposure were (4.0±0.5) and (7.5±2.0) times, respectively.The observation group was better than the control group in those indexes(P<0.05).Conclusion The technique of minimally invasive incision through paraspinal muscle gap approach has a better recovery of vertebral body height and Cobb's angle as well as less trauma and less blood loss.It is effective for the treatment of thoracolumbar fractures without spinal cord injury and worth application.