中国修复重建外科杂志

中国修复重建外科杂志

小切口直视下植入普通椎弓根螺钉联合椎管穹隆状减压治疗双节段胸腰椎骨折伴神经损伤

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目的 探讨小切口直视下植入普通椎弓根螺钉联合椎管穹隆状减压治疗双节段胸腰椎骨折伴神经损伤的可行性、安全性及有效性。 方法 回顾分析 2011 年 11 月—2015 年 11 月,采用小切口直视下植入普通椎弓根螺钉联合椎管穹隆状减压治疗的 32 例双节段胸腰椎骨折伴脊髓损伤患者(联合手术组)临床资料;与同期 32 例采用传统切开椎弓根螺钉复位内固定术治疗的患者(传统手术组)进行比较。两组患者性别、年龄、致伤原因、伤后至手术时间、损伤节段以及神经功能 Frankel 分级比较,差异均无统计学意义(P>0.05),具有可比性。记录两组术中椎旁肌肉剥离长度、手术时间、术中出血量、术后引流量,以及术后切口疼痛情况,采用疼痛视觉模拟评分(VAS)进行评定;观察神经功能恢复情况。 结果 两组患者均获随访,联合手术组随访时间为 9~12 个月,平均 10.5 个月;传统手术组为 8~12 个月,平均 9.8 个月。联合手术组术中椎旁肌肉剥离长度、手术时间、术中出血量、术后引流量以及术后切口 VAS 评分均明显优于传统手术组(P<0.05)。联合手术组 2 例术中发生硬脊膜破裂,1 例术后 6 个月椎弓根螺钉拔出;传统手术组 1 例术中发生硬脊膜破裂,术后未出现钉棒断裂和拔出。X 线片复查示,两组患者椎管均充分减压;两组患者骨折均愈合。患者神经功能均获得一定程度恢复。 结论 小切口直视下植入普通椎弓根螺钉联合穹隆状椎管减压治疗双节段胸腰椎骨折伴神经损伤,在确保良好神经减压的同时能减少医源性创伤,具有安全、有效、微创的优点。

Objective To determine the feasibility, safety, and efficacy of common pedicle screw placement under direct vision combined with dome shaped decompression via small incision for double segment thoracolumbar fracture with nerve injury. Methods A retrospective analysis was performed on the clinical data of 32 patients with double segment thoracolumbar fracture with nerve injury undergoing common pedicle screw placement under direct vision combined with dome shaped decompression via small incision between November 2011 and November 2015 (combined surgery group), and another 32 patients undergoing traditional open pedicle screw fixation surgery (traditional surgery group). There was no significant difference in gender, age, cause of injury, time of injury-to-surgery, injury segments and Frankel classification of neurological function between two groups (P>0.05). The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, the visual analogue scale (VAS) of incision after surgery, and recovery of neurological function after surgery were evaluated. Results All cases were followed up 9 to 12 months (mean, 10.5 months) in combined surgery group, and 8 to 12 months (mean, 9.8 months) in traditional surgery group. The length of soft tissue dissection, the operative time, the blood loss during surgery, the postoperative drainage, and the postoperative VAS score in the combined surgery group were significantly better than those in the traditional surgery group (P<0.05). Dural rupture during surgery and pedicle screw pulling-out at 6 months after surgery occurred in 2 cases and 1 case of the combined surgery group; dural rupture during surgery occurred in 1 case of the traditional surgery group. The X-ray films showed good decompression, and fracture healing; A certain degree of neurological function recovery was achieved in two groups. Conclusion Common pedicle screw placement under direct vision combined with dome shaped decompression via small incision can significantly reduce iatrogenic trauma and provide good nerve decompression. Therefore, it is a safe, effective, and minimally invasive treatment method for double segment thoracolumbar fracture with neurological injury.

关键词: 胸腰椎骨折; 脊髓损伤; 椎管穹隆状减压

Key words: Thoracolumbar fracture; Spinal cord injury; Dome shaped decompression

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