改良微创椎弓根钉固定治疗胸腰段骨折

目的探讨改良微创椎弓根钉内固定技术治疗无神经症状的胸腰段压缩性骨折的方法及疗效。方法自2008年6月-2011年5月，选择20例无神经症状的胸腰段压缩性骨折的患者，采用改良Wiltse入路及改良的人字嵴顶点置钉方法完成椎弓根螺钉的置入。并与同期的20例行传统开放椎弓根螺钉植入患者对比分析围手术期参数，影像学指标，视觉模拟评（VAS），Oswestry下腰痛评分（ODD。结果所有患者均获得了完整的随访，随访时间为9-18个月，平均11．2个月。改良微创组较传统开放组不仅手术时间、切口长度、住院时间明显缩短，而且在术中出血、术后伤口引流量均显著减少（P〈0．05）。两组患者各自在术后后凸Cobb’s角、椎体前缘高度较术前均有显著的恢复（P〈0．05），同时术后VAS评分、ODI残障指数较术前明显减少（P〈0．05），两组的骨折愈合时间无明显差异（P〉O．05）。结论改良微创椎弓根钉内固定技术操作相对简便，安全，具有创伤小，出血少，投资少，手术时间短，有利于患者恢复。

Modified minimally invasive pedicle screws for the treatment ofthorac and lumbar fracture

Objective To explore the way and effect of modified minimally invasive pedicle screws fixiton for the treat ment ofthorac and lumbar vertebra compression fracture without neural impairment. Methods 20 cases ofthorac and lum bar fracture without neural impairment were enrolled from May 2008 to August 2011, the pedicle screws fixton were in serted through modified Wiltse paraspinal inlet surgery and modified shape crest. Perioperative parameter, pos toperative imaging index, visual analog scale （VAS） and Oswestry Disability Index （ODI） were compared with the treatment of conventional open pedicle screws osteosynthesis in other 20 cases. Results All cases were followed up from 9 to 18 months （mean 11.2months）. The operation time and length of stay in modified minimal invasive group were sig nificantly shorter than that in conventional group, the amount of operative bleeding and drainage ofpostoperation decre ased obviously （P〈0.05）. In each group, comparison of Cobb＇s angle, anterior vertebra height, VAS and ODI scores between pre and post operation were all significantly different （P〈0.05）. There was no significant difference in bone union between two groups （P〉0.05）. Conclusion This study shows that modified minimally invasive pedicle screws fixiton has the advantages of simple manipulation, less trauma and bleeding, short operation time, and is beneficial to recovery.