微创经皮椎弓根螺钉联合伤椎置钉治疗胸腰段脊椎骨折

摘要

Objective To explore clinical effect of the treatment of thoracolumbar fractures with minimally invasive percutaneous pedicle screws fixation and additional injured vertebrae screw fixation.Methods There were 26 patients with T11 ~L2 single segment vertebral fractures treated with minimally invasive percutaneous pedicle screw fixation combined with injured vertebrae screw fixation.Operative time,blood loss,the total length of the incision,the hospi-tal stay,pre-and postoperative anterior height of the injured vertebrae,Cobb angle and sagittal index was collected for statistical analysis.Results Operative time was 50~90 (64.9 ±8.5 )min.Blood loss was 30~120 (64.6 ± 23.0)ml.The hospital stay time was 6~11 (8.6 ±1.5)days.Back pain of all patients were obviously improved.26 patients had been followed up for 14~30(21.7 ±4.3)months.The anterior height of the injured vertebrae,Cobb an-gle and sagittal index were all significantly improved after operation(P<0.01).The anterior height of the injured ver-tebrae,Cobb angle and sagittal index had maintained well at final follow-up without internal fixation failure.Conclu-sions It is exactly certain that the treatment of minimally invasive percutaneous pedicle screws fixation combined with injured vertebrae screw fixation for thoracolumbar fractures is effective.It has the advantage in improving and maintaining the anterior height of the injured vertebrae and the kyphosis.In addition,it causes less trauma,less blood loss,quicker recovery,shorter hospital stay and less complication.%目的：探讨微创经皮椎弓根螺钉联合伤椎置钉治疗胸腰椎骨折的临床疗效。方法采用微创经皮椎弓根螺钉内固定术联合伤椎置钉治疗26例T11～L2单节段椎体骨折患者，对手术时间、术中出血量、切口总长度、住院天数及手术前后伤椎前缘高度、后凸Cobb角、矢状面指数等观察指标进行统计学分析。结果手术时间50～90（64.9±8.5）min；术中出血量30～120（64.6±23.0）ml；住院天数6～11（8.6±1.5）d；术后疼痛症状均明显缓解。26例均获得随访，时间14～30（21.7±4.3）个月。术后3 d和末次随访时的伤椎前缘高度、后凸Cobb角及矢状位指数与术前比较差异均有统计学意义（P＜0.01）。末次随访患者伤椎前缘高度、后凸Cobb角及矢状面指数维持良好，随访期内无内固定失败发生。结论微创经皮椎弓根螺钉联合伤椎置钉对伤椎直接复位及固定、在即刻固定、改善和维持伤椎前缘高度、后凸畸形方面有明显优势，治疗胸腰椎单节段骨折具有创伤小、出血少、可早期活动、住院时间短、并发症少等优点，疗效确切。