后正中入路Quadrant通道下椎管减压复位联合经皮椎弓根螺钉内固定术治疗合并神经损伤的单节段AO分型A3型胸腰段脊柱骨折

目的 比较后正中入路Quadrant通道下椎管减压复位联合经皮椎弓根螺钉内固定术和Wiltse入路椎弓根螺钉内固定联合椎板切除减压术治疗合并神经损伤的单节段AO分型A3型胸腰段脊柱骨折的临床疗效.方法 2017年1月—2020年1月,本院收治单节段AO分型A3型胸腰段脊柱骨折患者67例,其中采用后正中入路Quadran...

Spinal canal decompression and reduction under Quadrant channel via posterior midline approach combined with percutaneous pedicle screw fixation for treatment of single-segment AO-A3 thoracolumbar fracture with nerve injury

Objective To compare the clinical efficacy of Quadrant canal decompression and reduction via posterior midline approach combined with percutaneous pedicle screw fixation and Wiltse approach pedicle screw fixation combined with laminectomy and decompression in the treatment of single-segment AO-A3 thoracolumbar fractures with nerve injury. Methods From January 2017 to January 2020,67 patients with single-segment AO-A3 thoracolumbar fractures were treated in our hospital,including 32 cases treated with Quadrant canal decompression and reduction via posterior midline approach combined with percutaneous pedicle screw fixation(Quadrant group),and 35 with Wiltse approach pedicle screw fixation combined with laminectomy and decompression(Wiltse group). The operation time,intraoperative blood loss,postoperative hospital stay and operation related complications of the 2 groups were recorded. Serum creatine kinase(CK) level were detected at pre-operation,postoperative 1 d and postoperative 7 d. The anterior edge height ratio of injured vertebra,posterior edge height ratio of injured vertebra,local kyphosis Cobb''s angle and the occupancy ratio of intraspinal fracture fragment were measured at pre-operation,postoperative 3 months and postoperative 12 months. Visual analogue scale(VAS) score and Oswestry disability index(ODI) were used to evaluate the pain intensity and functional status at pre-operation and postoperative 12 months. The neurological function was evaluated by American Spinal Injury Association(ASIA) classification,and the degree of fat infiltration in paravertebral muscle was evaluated by Goutallier classification at pre-operation and postoperative 12 months. Results All the patients were followed up for (18.60±6.13)months. The operation time of Quadrant group was longer than that of Wiltse group,and the postoperative hospital stay was shorter than that of Wiltse group,and the differences were statistically significant(P<0.05). The serum CK level at postoperative 1 d in Quadrant group was lower than that in Wiltse group,with a statistical significance(P<0.05);there was no significant difference between the 2 groups at postoperative 7 d(P>0.05). The anterior edge height ratio of injured vertebra,posterior edge height ratio of injured vertebra,local kyphosis Cobb''s angle,the occupancy ratio of intraspinal fracture fragment,VAS score and ODI of the 2 groups at post-operation were significantly improved compared with those at pre-operation,and Quadrant group was better than Wiltse group,the differences were statistically significant(P<0.05). At postoperative 12 months,ASIA classification of neurological function and Goutallier classification of paravertebral muscle fat infiltration of the 2 groups were significantly improved compared with those at pre-operation,all with a statistical significance(P<0.05);but there was no statistical significance between the 2 groups(P>0.05). Conclusion The effect of Quadrant canal decompression and reduction via posterior midline approach combined with percutaneous pedicle screw fixation in the treatment of single-segment AO-A3 thoracolumbar fractures with nerve injury is similar to Wiltse approach pedicle screw fixation combined with laminectomy and decompression,with smaller surgical trauma,faster postoperative recovery,and better recovery of vertebral height and effective volume in spinal canal.