脊柱全内镜下椎管减压经皮椎弓根螺钉固定治疗单节段胸腰椎爆裂性骨折的疗效分析

Clinical efficacy of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fracture

中文关键词:  胸腰椎爆裂性骨折  脊柱全内镜  椎管减压  经皮椎弓根螺钉内固定

英文关键词:Thoracolumbar burst fracture  Full-endoscope  Spinal canal decompression  Percutaneous pedicle screw fixation

中文摘要:

  【摘要】 目的：探讨脊柱全内镜下椎管减压结合经皮椎弓根螺钉内固定治疗单节段胸腰椎爆裂性骨折的安全性及早期疗效。方法：回顾性分析2021年4月～2022年6月在我院采用脊柱全内镜下椎管减压、经皮椎弓根螺钉内固定手术治疗的9例单节段胸腰椎爆裂性骨折患者的临床资料，男7例，女2例；年龄23~61岁（39.3±9.1岁）。AO分型A型6例，B型2例，C型1例。骨折节段：T12 2例，L1 3例，L2 3例，L3 1例。美国脊髓损伤协会（American Spinal Injury Association，ASIA）残损分级：C级2例，D级2例，E级5例。采用与伤椎置钉同切口脊柱全内镜下减压经皮椎弓根螺钉内固定。记录患者手术相关指标和并发症发生情况，术前、术后3d和末次随访时采用视觉模拟（visual analogue scale，VAS）评分评估患者腰痛程度，在脊柱X线片和CT上测量矢状位Cobb角、椎体前缘高度比及椎管侵占率； 末次随访时评估患者神经功能恢复情况。结果：9例患者均顺利完成手术，手术时间105~145min（112.4±21.2min），出血量50~110mL（83.9±19.6mL），住院时间7~13d（9.1±1.3d）。无伤口感染、脑脊液漏、神经损伤加重等严重并发症发生。随访时间6~13个月（8.4±3.9个月），骨折均顺利愈合，愈合时间3~6个月（4.7±1.6个月）。术后3d及末次随访时的腰痛VAS评分与术前比较均有显著性改善（P<0.05），末次随访时与术后3d比较亦有显著性改善（P<0.05）。术后3d及末次随访时的Cobb角、椎前缘高度比及椎管侵占率与术前比较均有显著性改善（P<0.05），末次随访时与术后3d比较均无统计学差异（P>0.05）。末次随访时神经功能1例由C级恢复至D级，另3例神经损伤患者完全恢复。结论：经伤椎置钉同切口脊柱全内镜下椎管减压结合经皮椎弓根螺钉内固定治疗单节段胸腰椎爆裂性骨折可获得有效的神经根及椎管减压，矫形效果良好，手术创伤小，安全有效。

英文摘要:

  【Abstract】 Objectives: To explore the safety and early effectiveness of decompression under full-endoscope and percutaneous pedicle screw fixation in the treatment of single-level thoracolumbar burst fractures. Methods: The clinical data of 9 patients with single-segment thoracolumbar burst fracture treated with spinal canal decompression under full-endoscope and percutaneous pedicle screw fixation from April 2021 to June 2022 in our hospital were analyzed retrospectively, including 7 males and 2 females. The age ranged from 23 to 61(39.3±9.1) years old. According to AO classification, there were 6 cases of type A, 2 cases of type B and 1 case of type C. Fracture segments were T12 in 2 cases, L1 in 3 cases, L2 in 3 cases, and L3 in 1 case. According to the classification of American Spinal Injury Association(ASIA) grading, there were 2 cases of type C, 2 cases of type D, and 5 cases of type E. The decompression and percutaneous pedicle screw fixation were operated through the same incision in the injured vertebrae for screw placing. The operation-related indexes and complications were recorded. The patients′ low back pain was evaluated by visual analogue scale(VAS) score before operation, on 3rd day after operation and at the last follow-up. The sagittal Cobb angle, height ratio of vertebral anterior edge, and the rate of spinal canal occupation were measured on spinal X-ray and CT images, and the recovery of neurological function was evaluated at the last follow-up. Results: All 9 patients successfully completed the operation, and the operative time was 105-145min(112.4±21.2min), bleeding volume was 50-110mL(83.9±19.6mL), and hospitalization time was 7-13d(9.1±1.3d). No serious complications such as wound infection, cerebrospinal fluid leakage, aggravated nerve injury occurred. The follow-up time was 6-13months(8.4±3.9 months), all the fractures healed successfully, and the healing time was 3-6 months(4.7±1.6 months). The VAS score of low back pain on the 3rd day after operation and at final follow-up significantly improved compared with that before operation(P<0.05), and it was also significantly improved at the last follow-up compared with that on the 3rd day after operation(P<0.05). The Cobb angle, anterior height ratio of injured vertebrae, and invasion rate of spinal canal were significantly improved compared with those before operation(P<0.05), respectively, but there was no statistical difference between the last follow-up and postoperative 3d(P>0.05). One patient recovered from grade C to grade D of ASIA classification, while another three patients with neurological injury recovered completely. Conclusions: Decompression under full-endoscope and percutaneous pedicle screw fixation through the same incision in the injured vertebrae for screw placement in the treatment of single-level thoracolumbar burst fractures can obtain effective nerve root and spinal canal decompression, with good correction and small operative trauma, which is a safe and effective option.