后路通道下与开放式椎管减压椎弓根螺钉固定治疗伴神经损伤的胸腰椎骨折

Treatment of thoracolumbar fracture with nerve injury by laminotomy decompression and internal fixation through posterior channel or open surgery

中文关键词:  胸腰椎爆裂型骨折  椎板间隙  经皮椎弓根螺钉  植骨

英文关键词:Thoracolumbar burst fractures  Lamina space  Percutaneous pedicle screws  Bone graft

中文摘要:

  【摘要】 目的：探讨后路通道下椎管减压联合经皮椎弓根螺钉固定（微创组）与开放式椎管减压椎弓根螺钉固定（开放组）治疗伴神经损伤的胸腰椎骨折的疗效。方法：纳入2013年1月～2016年3月行手术治疗的伴神经损伤的胸腰椎骨折患者共66例，微创组31例，男23例，女8例；开放组35例，男25例，女10例。整理分析两组病例基础临床资料（年龄、性别比、受伤机制、伤椎分布、Denis分型、ASIA分级及术前VAS评分）、术后及各阶段随访的影像学参数（伤椎椎管通畅率、伤椎前缘高度百分比、Cobb角）。结果：两组间基础临床资料比较无显著性差异（P>0.05）。两组神经损伤恢复良好，无严重手术相关并发症。微创组随访26.58±5.98（14~38）个月，开放组为27.09±6.73（16~44）个月（P>0.05）。两组手术时间、植骨量无统计学差异（P>0.05）；但术中出血（359.68±159.22ml vs 514.86±246.09ml）、自体血回输（7 vs 17例）、止痛药使用（12 vs 23例）、住院时间（9.48±2.72d vs 11.51±3.27d）及术后1周VAS评分（3.77±1.28 vs 4.97±1.44分）微创组均优于开放组，差异有统计学意义（P<0.05）。两组术后1周、术后3个月、末次随访时椎管通畅率、伤椎椎体前缘高度百分比、矢状面Cobb角分别较术前改善，差异有显著性（P<0.05）；但术前、术后1周、术后3个月、末次随访时椎管通畅率、伤椎椎体前缘高度百分比、矢状面Cobb角两组间比较均无显著性差异（P>0.05）。结论：针对严重椎管狭窄伴神经损伤的胸腰椎骨折病例，微创置钉联合小切口入路椎板减压植骨内固定术与传统开放术式均取得了良好的疗效。微创术式在减少手术创伤、出血量、住院时间等方面更具优势。

英文摘要:

  【Abstract】 Objectives: To investigate the efficacy of treatment of thoracolumbar fracture with nerve injury by laminotomy decompression and internal fixation through posterior channel or open surgery. Methods: 66 cases of thoracolumbar fracture with nerve injury were recruited from January 2013 to March 2016, 31 cases(male, 23; femal, 8) underwent posterior minimal invasive decompression combined with percutaneous pedicle screw fixation(Mini-group), and 35 cases(male, 25; femal, 10) underwent traditional open posterior decompression and pedicle screw fixation(Open-group). The basic clinical data(age, sex ratio, injury mechanism, spinal distribution, Denis classification, ASIA classification and preoperative VAS score) of the two groups were analyzed and the imaging parameters were followed up: the spinal canal patency rate(SCP), percentage of anterior vertebral height of injured vertebra(AVH), and the Cobb angle(CA). Results: There were no significant differences between two groups of basic clinical data(P>0.05). The results of two groups showed that the nerve injury recovered well and no serious operative complications occurred. Mini-group achieved 26.58±5.98(14-38) months follow-up, and Open-group achieved 27.09±6.73(16-44) months(P>0.05). There was no statistically significant difference(P>0.05) between two groups in operation time or bone grafting mass. But the intraoperative hemorrhage(359.68±159.22ml vs 514.86±246.09ml), autologous blood transfusion(7 vs 17 cases), analgesics usage(12 vs 23 cases), hospitalization(9.48±2.72d vs 11.51±3.27d) and postoperative VAS score(3.77±1.28 vs 4.97±1.44) were better in Mini-group, compared with those of Open-group, the differences were statistically significant(P<0.05). In two groups, at 1 week, 3 months and final follow-up, the SCP, AVH and CA improved compared to those before operation, and there were statistical differences(P<0.05). But there was no significant difference in SCP, AVH or CA between two groups(P>0.05). Conclusions: For thoracolumbar fracture with severe spinal stenosis and nerve injury, minimally invasive nailing by small incision approach for decompression, bone grafting and internal fixation, as well as the traditional open surgery achieve good curative effect. Nevertheless, minimally invasive surgery has more advantages in reducing surgical trauma, bleeding volume and drainage volume.