椎间盘镜减压经皮椎弓根螺钉棒治疗胸腰椎爆裂骨折

发布时间：2018-06-13 08:03

本文选题：胸腰椎爆裂性骨折 + 微创　；参考：《中国矫形外科杂志》2017年12期

【摘要】：[目的]探讨后路椎间盘镜下减压、经伤椎椎弓根植骨结合经皮椎弓根螺钉内固定术微创治疗胸腰椎爆裂性骨折的早期疗效及临床体会。[方法]2012年9月~2015年9月,采用上述技术治疗单一椎骨胸腰椎爆裂性骨折32例,其中男21例,女11例。分别评估术前、术后3个月、术后1年伤椎前缘高度、脊柱后凸角(cobbs角)、椎管正中矢状径、VAS评分及神经功能Frankel分级。[结果]手术均顺利完成,切口均甲级愈合,术中未出现硬膜囊撕破情况;随访12~34个月,平均18.5个月;术后3个月及1年的伤椎前缘高度、脊柱后凸Cobb角、椎管正中矢状径、VAS评分均较术前明显改善(P0.05);术后3个月与1年的各项指标间比较差异均无统计学意义(P0.05);术前16例伴有神经症状,术后1年时15例完全恢复,1例Frankel分级由C级恢复到D级。术后骨折均得以较好复位,未见内固断裂、松脱及矫形丢失等并发症。[结论]后路椎间盘镜下减压、经伤椎椎弓根植骨结合经皮椎弓根螺钉内固定术,能对中央椎管及神经根进行有效的减压,有利于神经功能的恢复,且能使骨折获得满意的复位,重建脊椎三柱的稳定性,是治疗胸腰椎爆裂性骨折一种安全、可行、有效的手术方式。
[Abstract]:[objective] to investigate the early curative effect and clinical experience of posterior disc decompression, pedicle bone grafting and percutaneous pedicle screw fixation in the treatment of thoracolumbar burst fracture. [methods] from September 2012 to September 2015, 32 cases of single vertebral thoracolumbar burst fracture were treated with the technique mentioned above, including 21 males and 11 females. The anterior height of injured vertebrae, cobbs angle of kyphosis angle, VAS score of median sagittal diameter of spinal canal and Frankel grade of nerve function were evaluated before operation, 3 months after operation and 1 year after operation. [results] all the operations were successfully completed, the incision healed in grade A, and there was no tear of dural sac during the operation, followed up for 12 ~ 34 months (mean 18.5 months), the height of the anterior edge of the injured vertebrae and the Cobb angle of kyphosis were 3 months and 1 year after operation. The VAS score of median sagittal diameter of spinal canal was significantly improved than that of preoperation (P 0.05), and there was no significant difference between the indexes of 3 months and 1 year after operation (P 0.05). At 1 year after operation, 15 cases recovered completely and 1 case recovered from C grade to D grade. After operation, all the fractures were well reduced, and no complications such as internal solid fracture, loosening and orthopedic loss were observed. [conclusion] posterior disc decompression, transpedicular bone grafting and percutaneous pedicle screw fixation can effectively decompress the central spinal canal and nerve root, which is beneficial to the recovery of nerve function. It is a safe, feasible and effective method to treat thoracolumbar burst fracture.
【作者单位】：解放军武汉总医院;湖北中医药大学;
【分类号】：R687.3

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