体位复位经皮微创椎弓根螺钉内固定治疗无神经症状的胸腰椎重度压缩骨折

目的：探讨体位复位经皮微创椎弓根螺钉内固定治疗无神经症状的胸腰椎重度压缩骨折的临床疗效。方法2013年1月至2015年3月，西安交通大学医学院附属红会医院脊柱科采用体位复位经皮微创椎弓根螺钉内固定治疗48例无神经症状的单节段胸腰椎重度压缩骨折（压缩≥50%）病人，记录手术时间、术中出血量、术后切口愈合情况及并发症，观察并比较其术前、体位复位后、内固定撑开后及术后1、12个月的椎体高度丢失率、Cobb角，比较其术前及术后1、12个月的疼痛视觉模拟量表（visual analogue scale, VAS）评分及Oswestry功能障碍指数（Oswestry disability index, ODI）。结果所有病人手术均顺利完成，获得12个月随访。术中出血量为（75.4±10.0）ml，手术时间为（50.0±9.5）min；体位复位后及椎弓根螺钉撑开固定后的椎体前缘高度丢失率及中部高度丢失率、Cobb角均较术前显著降低，差异均有统计学意义（均P＜0.05），随访12个月未见明显变化；体位复位后伤椎前缘高度恢复＜50%与≥50%的病人于内固定撑开后的椎体前缘高度丢失率相比，差异有统计学意义（t=2.121，P=0.039）。术后随访时的VAS评分及ODI均较术前改善，差异均有统计学意义（均P＜0.05）。术后12个月，3例病人出现伤椎“蛋壳”现象，取出内固定，CT引导下行空腔骨水泥灌注术。结论体位复位经皮微创椎弓根螺钉内固定术是治疗无神经症状胸腰椎重度压缩骨折安全有效的方法，但是对于体位复位未达50%者可能出现术后复位不满意，继续行经皮微创内固定需谨慎。

Postural reduction and minimally invasive percutaneous pedicle screws reduction osteosynthesis for thoracolumbar vertebral severe compression fractures

Objective To investigate the feasibility and effect of postural reduction and minimally invasive percutaneous pedicle screws reduction osteosynthesis for thoracolumbar vertebral severe compression fractures. Methods From January 2013 to March 2015, 48 patients with single segment thoracolumbar verte?bral severe compression fractures without nervous system in Honghui Hospital were treated with postural reduc?tion and minimally invasive percutaneous pedicle screws reduction osteosynthesis. The perioperative data such as operative time, blood loss volume, complications, postoperative incision were recorded. The visual analogue scale (VAS) scores and Oswestry disability index (ODI), vertebral height and Cobb angle before and after surgery were evaluated. Results All patients received 12 months follow?up, and blood loss and operative time were (75.4 ± 10.0) ml and (50.0 ± 9.5) min respectively. The anterior flange height loss and central vertebral height loss were significantly reduced (P<0.05 for all). There was significant difference in the vertebral reduction rate between the patients with anterior height of vertebral recovered <50%and those≥50%(t=2.121, P=0.039). VAS score and ODI were improved significantly after operation as compared with those preoperation (P<0.05 for all). At 12th month after operation, 3 cases had injured vertebral eggshell phenomenon, the inter?nal fixators were removed, and bone cement perfusion was given under CT guidance. Conclusion Postural reduction and minimally invasive percutaneous pedicle screws reduction osteosynthesis technique is preferred method of thoracolumbar severe compression fractures without neurological symptoms, but for the postural reduction failed to reach 50%vertebral height reduction, minimally invasive percutaneous pedicle screws reduc?tion osteosynthesis needs to be cautious.