经椎旁肌间隙入路钉棒系统内固定治疗胸腰椎骨折

经椎旁肌间隙入路钉棒系统内固定治疗胸腰椎骨折

【摘要】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。

【关键词】胸腰骨折；椎旁肌间隙入路；微创

Surgical treatment of thoracolumbar fractures with pedicle screw and rod fixation system through paraspinal approach CHENG Wen-dan, LI Pin, JIANG Huai, et al. Department of

Orthopedics, Lu'an People's Hospital Afflicted to Anhui Medical University, Lu'an 230075, China

【Abstract】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

ain

of the anterior border and the Cobb’s angle restoration and p 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

4.6)%, the

height of the anterior border was corrected to (90.2±

AS was (1.9±0.8). Compared Cobb’s angle was (5.7±1.6)°and V

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.

【Key words】Thoracolumbar fracture; Paraspinal approach; Minimally invasive传统的经后路椎弓根螺钉系统复位内固定

是目前治疗胸腰椎骨折最常用的手术方法, 具有显露充分、

操作方便、能有效通过间接复位重建椎体高度、恢复生理弧

度的优点［1］。但由于椎旁肌的广泛剥离、牵开显露, 易导致椎旁肌损伤、瘢痕形成、失神经萎缩纤维化, 从而引起长

期腰背痛和腰椎失能, 是腰椎术后失败综合征的主要原因［2, 3］。本科2010年9月~2012年12月, 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, 疗效满意, 现报告如下。

1资料与方法

1. 1一般资料本组27例患者, 男17例, 女10例, 年龄21~58岁, 平均37.4岁。致伤原因：车祸伤11例, 高处坠落伤13例, 重物砸伤3例, 排除病理性骨折。Denis分型：单

纯压缩性骨折8例, 爆裂性骨折19例。损伤节段：T11 2例, T12 9例, L1 12例, L2 4例。临床表现：胸腰背部疼痛, 双下肢及鞍区感觉正常, 大小便正常, Frankel分级：E级。合并其他部位骨折4例, 肺或颅脑损伤2例。手术时间在伤后1~ 6 d,