摘要
目的探讨经椎间盘镜下减压、植骨、经皮椎弓根螺钉内固定治疗胸腰椎爆裂性骨折的临床疗效。方法纳入2015年4月~2016年10月收治的42例胸腰椎爆裂性骨折患者,均为骨折块突入椎管且合并神经损伤。采用椎间盘镜下减压、植骨、经皮椎弓根螺钉内固定治疗,术后随访超过2年,评价手术疗效。结果42例患者均顺利完成手术,手术时间(120.42±32.91)min,出血量(92.65±7.76)ml,住院时间(9.22±1.02)d;随访(2.32±0.27)年;术后1周、6个月、2年的VAS评分、Cobb角较术前均显著降低,伤椎前缘高度、椎管正中矢状径显著增加,差异有统计学意义(P<0.05),术后2年与术后1周、6个月的Cobb角、伤椎前缘高度比差异有统计学意义(P<0.05);术后2年ASIA分级较术前显著改善(P<0.05);术后3d有1例患者出现浅表切口感染,1例术后5个月出现间歇性腰部疼痛,无内固定松动、脑脊液漏等严重并发症发生。结论椎间盘镜下减压、植骨、经皮椎弓根螺钉内固定能获得有效的神经根及椎管减压效果,内固定稳固,矫正效果良好,手术创伤小,安全有效。
Objective To analyze the clinical efficacy of decompression,bone grafting and percutaneous pedicle screw fixation under diskoscope in the treatment of thoracolumbar burst fractures.Methods Forty-two patients with thoracolumbar burst fractures were enrolled from April 2015 to October 2016.All of them were fracture fragments protruding into the spinal canal and complicated with nerve injury.Discoscopic decompression,bone grafting and percutaneous pedicle screw internal fixation were used.The patients were followed up for more than 2 years to evaluate the effect of the operation.Results All 42 patients successfully completed the operation,the operation time was(120.42±32.91)min,the bleeding volume was(92.65±7.76)ml,the hospitalization time was(9.22±1.02)d;the follow-up was(2.32±0.27)years;the postoperative week was 1 week and June.The VAS score and Cobb angle at 1 week,6 months and 2 years after operation were significantly lower than those before operation.The anterior height of injured vertebra and the median sagittal diameter of vertebral canal were significantly increased(P<0.05).There were significant differences in the ratio of Cobb angle and the anterior height of injured vertebra between 2 years after operation and 1 week,6 months after operation(P<0.05).There were 1 case of superficial incision infection 3 days after operation,1 case of intermittent lumbar pain 5 months after operation,and no serious complications such as loosening of internal fixation and cerebrospinal fluid leakage occurred.Conclusion Decompression of the disc,bone grafting,and percutaneous pedicle screw fixation can obtain effective nerve root and spinal canal decompression effects.The internal fixation is stable,the correction effect is good,the surgical trauma is small,and it is safe and effective.
作者
刘红光
吴小涛
黄爱兵
李海俊
LIU Hong-guang;WU Xiao-tao;HUANG Ai-bing;LI Hai-jun(Orthopaedics Department of Taizhou People's Hospital,Taizhou,Jiangsu 225300,China;Orthopaedics Department of Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu 210009,China)
出处
《颈腰痛杂志》
2019年第5期614-616,共3页
The Journal of Cervicodynia and Lumbodynia
关键词
椎间盘镜
减压
植骨
经皮椎弓根螺钉内固定
胸腰椎爆裂性骨折
Discectomy
Decompression
Bone Graft
Percutaneous Pedicle Screw Fixation
Thoracolumbar Burst Fracture
