侧入路微创椎间融合结合后路短节段固定治疗胸腰段骨折的初步临床疗效

The preliminary results of minimally invasive lateral lumbar interbody fusion combined with posterior short-segment instrumentation for thoracolumbar fractures

中文关键词:  胸腰椎骨折  侧入路椎间融合  脊柱微创  短节段固定

英文关键词:Thoracolumbar fractures  Lateral interbody fusion  Minimally invasive spine surgery  Short-segment instrumentation

中文摘要:

  【摘要】 目的：探讨侧入路微创椎间融合结合后路短节段椎弓根螺钉内固定治疗累及三柱的胸腰段骨折的初步临床疗效。方法：2009年10月～2012年9月，采用后路短节段椎弓根螺钉内固定结合二期侧入路微创椎间融合技术治疗符合入选标准的累及三柱的胸腰段骨折患者12例，包括男10例，女2例，平均年龄33±9.4岁（21～47岁）。所有患者首先接受后路短节段椎弓根钉内固定，2周后接受侧入路微创椎间融合重建脊柱前中柱稳定性。侧入路微创椎间融合采用自行设计的工作通道，融合节段包括T11/12 4例，T12/L1节段5例，L1/2节段3例。分别记录前后路手术的手术时间、手术出血量及手术相关并发症情况。在术前、术后以及末次随访时分别采用ASIA 2011标准以及Cobb角评价患者神经功能情况以及矫正维持情况。末次随访时采用Suk标准评价植骨融合情况。结果：后路手术时间平均125.8±29.0min，手术出血量平均460.5±88.1ml；侧入路微创椎间融合手术时间平均127.1±21.7min，手术出血量平均185.8±62.3ml。侧入路椎间融合相关手术并发症包括术后穿刺侧血胸1例，穿刺侧神经根损伤1例。随访时间平均12.75±4.6个月。患者术前平均Cobb角31°±8.7°，侧入路椎间融合术后平均Cobb角5.1°±3.5°，随访过程中平均矫正丢失4.3°±2.1°。末次随访时骨性融合8例（66.7%），可疑融合4例（33.3%），无植骨不融合及假关节病例；术前不完全损伤者中有5例出现至少1个级别的神经功能提高，其他患者神经功能无改善；无内固定失败病例。结论：侧入路微创椎间融合结合后路短节段固定治疗累及三柱的胸腰段骨折可取得满意的治疗效果，是否可作为传统前后路开放手术的替代或补充有待更多病例更长时间观察。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes of minimally invasive lateral lumbar interbody fusion(LLIF) combined with posterior short-segment instrumentation for thoracolumbar fractures. Methods: From Octomber 2009 to September 2012, twelve patients with thoracolumbar fractures who met the inclusion criteria were treated with posterior short-segment pedicle instrumentation combined with delayed minimally invasive LLIF. There were 10 males and 2 females with a mean age of 33±9.4 years(21-47 years). All the patients underwent posterior short-segment pedicle instrumentation as the initial treatment. Minimally invasive LLIF was performed within two weeks after the posterior procedure, under the assistance of self-designed working-tunnel. The levels of LLIF included T11/12 in 4 patients, T12/L1 in 5 and L1/2 in 3. The evaluation index included average operation time, average blood loss and complication associated with the surgery. ASIA impairment scale(2011) and Cobb angle were used to evaluated the neurological function and the loss of correction preoperatively, postoperatively and at final follow-up, respectively. The status of fusion was evaluated according to Suk′s criteria at final follow-up. Results: All the patients tolerated the operation well. The mean operation time and blood loss of the posterior procedure was 125.8±29 minutes and 460±88.1ml, respectively, while 127.1±21.7 minutes and 185.8±62.3ml, respectively for the minimally invasive LLIF procedure. Hemopneumothorax was noted in 1 case after the minimally invasive LLIF procedure. One patient presented with neurological deficit after LLIF procedure. The mean follow-up period was 12.75±4.6 months. The mean Cobb angle improved from 31°±8.7° preoperatively to 5.1°±3.5° postoperatively. At final follow-up a mean of 4.3°±2.1° of loss of correction was noted. Solid fusion was achieved in 8 patients(66.7%) and probable fusion was in 4 patients(33.3%). Five patients with incomplete spinal cord injury achieved at least one grade of neurological function improvement, others had no change. No implant failure was noted. Conclusions: Posterior short-segment pedicle instrumentation combined with minimally invasive LLIF is effective for indicative thoracolumbar fractures, if it can be used for an alternative or complementary treatment for conventional wide-open combined anterior and posterior approaches, needs more cases and longer observation.