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

发布时间：2018-06-01 22:50

本文选题：胸腰椎骨折 + 脊髓损伤　；参考：《中国修复重建外科杂志》2017年06期

【摘要】：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(P0.05),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(P0.05)。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。
[Abstract]:Objective to investigate the feasibility, safety and efficacy of pedicle screw implantation combined with spinal canal fornix decompression in the treatment of bilateral thoracolumbar fractures with nerve injury. Methods from November 2011 to November 2015, 32 cases of double-level thoracolumbar fractures with spinal cord injury were treated with pedicle screw implantation combined with spinal canal fornix decompression under the direct vision of small incision (combined operation group). A comparison was made between 32 patients with traditional pedicle screw reduction and internal fixation in the same period (traditional operation group). There were no significant differences in sex, age, cause of injury, time from injury to operation, injury segment and Frankel grade of nerve function between the two groups (P 0.05). The length of paraspinal muscle dissection, operative time, intraoperative blood loss, postoperative drainage and postoperative incision pain were recorded and evaluated by visual analogue pain score (VASS), and the recovery of nerve function was observed. Results two groups of patients were followed up, the follow-up time of combined operation group was 9 ~ 12 months (mean 10.5 months), and that of traditional operation group was 8 ~ 12 months (mean 9.8 months). The paraspinal muscle dissection length, operative time, intraoperative blood loss, postoperative drainage volume and postoperative incision VAS score in the combined operation group were significantly better than those in the traditional operation group (P 0.05). In the combined operation group, the dural rupture occurred in 2 cases and the pedicle screw was pulled out 6 months after operation in 1 case in the combined operation group, and in the traditional operation group, the dural rupture occurred in 1 case during the operation, and there was no rupture of the nail rod and pull-out X-ray film after operation. The vertebral canal was decompressed fully in both groups and the fracture healed in both groups. The neurological function of all patients recovered to a certain extent. Conclusion it is safe, effective and minimally invasive to treat bilateral thoracolumbar fractures with nerve injury by implanting common pedicle screw and decompression of fornix spinal canal under the direct vision of small incision, which can reduce iatrogenic trauma while ensuring good nerve decompression.
【作者单位】：重庆市人民医院脊柱外科;
【分类号】：R687.3

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