摘要
[目的]探讨基于通道技术的微创椎弓根螺钉内固定治疗胸腰椎骨折的安全性及有效性。[方法]2013年5月～2014年5月选择20例无神经损伤胸腰椎骨折患者采用PIPELINE可扩张微创通道下椎弓根螺钉内固定术,记录手术时间、术中出血量、住院天数、置钉优良率及功能优良率,以及疼痛评分(VAS)、矢状位Cobb角、椎体压缩率。[结果]所有20例患者均顺利手术,手术时间(90.63±12.58)min;术中出血量(84.74±16.89)ml;住院天数(10.80±1.28)d,置钉优良率100%,无切口感染和其他严重并发症发生。所有病例均获得随访,随访时间3～15个月,平均(11.42±2.32)个月。随时间延长,VAS评分明显减小,差异有统计学意义(P<0.05),术后3 d的椎体前缘高度百分比与术前比较明显增大,差异有统计学意义(P<0.05)。而末次随访的椎体前缘高度百分比较术后3 d稍减小,但差异无统计学意义(P>0.05),术后3 d的伤椎矢状位Cobb角与术前比较明显减小,差异有统计学意义(P<0.05),而末次随访的伤椎矢状位Cobb角较术后3 d稍增大,但差异无统计学意义(P>0.05)。改良MacNab功能评价标准评估末次随访时手术优良率为95%。[结论]基于通道技术的微创椎弓根螺钉内固定治疗无神经损伤胸腰椎骨折近期疗效满意,具有创伤小、出血少、术后疼痛轻、恢复快等优势。
[Objective] To investigate the safety and effectiveness of minimally invasive pedicle screw fixation based on channel technique for treatment of thoracolumbar fracture. [Methods] From May 2013 to May 2014, 20 patients received pedi- cle screw fixation under PIPELINE expansible minimally invasive channel for thoracotumbar fractures without nerve injury. The operation time, intraoperative bleeding, hospitalization, screw placement, functional recovery, as well as pain score （VAS）, ante- rior vertebral height ratio and sagittal Cobb angle and were analyzed. [Results] All the 20 patients had operation performed smoothly with operation time of （90.63±12.58） min, intraoperative bleeding of （84.74v16.89） ml, hospital stay of （10.80±1.28） d, and the excellent screw placement rate of 100%, whereas without incisional infection and other serious complications in any of them. All of them were followed up for 3 to 15 months with an average of （11.42±2.32） months. The VAS significantly decreased over time with statistical differences among the time points （P〈0.05）. The anterior vertebral height ratio at 3 days postoperatively was significantly increased compared with that before operation （P〈0.05）, although it slightly decreased at the latest follow up without a statistical difference between the two points （P〉0.05）. In addition, the sagittal Cobb angle at 3 days postoperatively was significantly less than that before operation （P〈0.05） , despite the fact that the Cobb angle at the latest follow-up increased to some extent compared with that 3 days postoperatively, but the difference was not statistically significant （P〉 0.05） . In term of MacNab criteria, the results at the latest follow up were graded as excellent in 95% of the patients. [Conclusion] Minimally invasive pedicte screw fixation based on channel technology achieve satisfactory short-term outcomes for thoracolumbar fracture without nerve injury, associat- ed with advantages of minimized trauma, less bleeding, d
作者
林永绥
刘成招
王春
杨朝勃
胡杨华
凌广烽
LIN Yong- sui;LIU Cheng-zhao;WANG Chun;YANG Chao-bo;HU Yang-hua;LING Guang-feng(Department of Spine Surgery,the Affiliated Mindong Hospital,Fujian Medical University,Fu＇an 355000,China;Department of Orthopaedics,Public Health Clinical Center,Shanghai 201508,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第14期1278-1282,共5页
Orthopedic Journal of China
基金
福建省自然科学基金项目(编号：2014J01441)
福建医科大学非直属附属医院科研发展专项基金项目(编号：FZS13017Y)
宁德市科技计划项目(编号：20130113)
关键词
微创
通道技术
椎弓根螺钉
胸腰椎骨折
minimally invasive surgery
channel technology
pedicle screw
thoracolumbar fracture
