后路短节段伤椎经皮椎弓根螺钉内固定治疗A3型和A4型胸腰段骨折

Percutaneous short-segment pedicle screw fixation using pedicle fixation at fractured level without fusion in the treatment of type A3 or A4 thoracolumbar fractures

中文关键词:  胸腰椎骨折  椎弓根螺钉  微创  经皮  内固定

英文关键词:Thoracolumbar fracture  Pedicle screw  Minimally invasive  Percutaneous  Internal fixation

中文摘要:

  【摘要】 目的：探讨单纯后路短节段结合伤椎经皮椎弓根螺钉内固定治疗A3型和A4型胸腰段骨折的临床疗效。方法：选择2013年9月～2014年2月无神经损伤、Loadsharing评分≤6分、单椎体A3型或A4型胸腰段骨折患者60例，分为经皮组（单纯后路短节段结合伤椎经皮椎弓根螺钉内固定）和经肌间隙组（后路经肌间隙短节段结合伤椎椎弓根螺钉内固定），两组间性别比例、年龄、骨折类型、骨折节段等一般资料间差异无显著性（P＞0.05），具有可比性。比较两组的围手术期指标（切口长度、手术时间、术中出血量和切口疼痛VAS评分）与影像学指标（伤椎前缘高度和矢状面Cobb角）指标。结果：两组手术切口长度、手术时间、术中出血量及术后切口疼痛经皮组分别为9.55±1.76cm、120.7±24.5min、50.6±13.7ml及3.5±1.0分；经肌间隙组分别为10.80±1.52cm、90.3±15.6min、152.0±25.8ml及5.1±1.7分，两组间差异除手术切口长度外均有统计学意义（P＜0.05）。两组术后即刻、取内固定时、末次随访时的伤椎前缘高度和矢状面Cobb角经皮组分别为（86.5±7.9）%和3.7°±4.5°、（84.5±8.1）%和3.9°±5.0°、（83.9±5.7）%和3.6°±4.5°；经肌间隙组分别为（88.1±8.6）%和3.2°±5.1°、（86.3±8.3）%和3.8°±5.4°、（85.6±7.1）%和3.7°±4.8°。与术前相比两组均得到明显纠正（P＜0.05），与术后即刻相比两组均没有明显丢失，两组间的影像学评价指标均无显著性差异（P＞0.05）。结论：在严格掌握手术适应证的前提下，单纯后路短节段结合伤椎经皮椎弓根螺钉内固定适用于治疗A3型和A4型胸腰段骨折，同时具有出血少、疼痛轻的优点。

英文摘要:

  【Abstract】 Objectives: To explore the clinical result of percutaneous short-segment pedicle screw fixation using pedicle fixation at fractured level without fusion for type A3 or A4 thoracolumbar fractures. Methods: Between September 2013 and February 2014, 60 patients suffering from thoracolumbar single-level vertebral fractures(type A3 or type A4, load sharing ≤ 6, without neurological deficit) were reviewed retrospectively. All cases were divided into two groups: percutaneous group (percutaneous short-segment pedicle screw fixation at fractured level without fusion) and trans-spatium intermuscular group (trans-spatium intermuscular short-segment pedicle screw fixation using pedicle fixation at fractured level without fusion). There were no significant differences in gender, age, type of fracture and level of fracture between the two groups. The perioperative parameters (including the length of incision, the operation time, the intraoperative blood loss and the VAS after operation) and radiographic parameters(including the anterior vertebral body height and the Cobb angle) were compared. Results: In percutaneous group, the length of incision was 9.55±1.76cm, the time of operation was 120.7±24.5min, the intraoperative blood loss was 50.6±13.7ml and the VAS after operation was 3.5±1.0 points; while in trans-spatium intermuscular group, the data were 10.80±1.52cm, 90.3±15.6min, 152.0±25.8 and 5.1±1.7 points respectively, which showed significant differences between the two groups(P＜0.05) except for the length of incision. In percutaneous group, the anterior vertebral body height and Cobb angle after operation, at the time of fixation removal and at final follow-up were 86.5±7.9% and 3.7±4.5°, 84.5±8.1% and 3.9±5.0°, 83.9±5.7% and 3.6±4.5° respectively. While in trans-spatium intermuscular group, the data were 88.1±8.6% and 3.2±5.1°, 86.3±8.3% and 3.8±5.4°, 85.6±7.1% and 3.7±4.8° respectively. Compared with preoperation, the anterior vertebral body height and Cobb angle after operation improved significantly in both groups(P＜0.05). Compared with the postoperation, there was no significant difference with regard to the recovery outcome between the time for fixation removal and the final follow-up in both groups(P＞0.05). There were no significant differences in radiographic parameters between the two groups. Conclusions: Percutaneous short-segment pedicle screw fixation using pedicle fixation at the level of fracture without fusion is a reliable surgical method for the treatment of type A3 and type A4 thoracolumbar fractures with the advantages of less intraoperative blood loss and less VAS after operation.