摘要
目的:探讨后路经皮椎弓根螺钉附加伤椎置钉结合预弯连接棒钉棒杠杆复位内固定、椎管间接减压技术治疗伴有神经功能损伤的A3胸腰椎骨折的临床疗效。方法:回顾性分析26例伴神经功能损伤A3型胸腰椎骨折患者,均于伤后3 d内行后路经皮椎弓根螺钉附加伤椎置钉结合预弯连接棒钉棒杠杆复位内固定、椎管间接减压术。记录并比较术前、术后、末次随访影像学观察指标、临床效果观察指标、手术相关指标及并发症情况,评估治疗效果。结果:患者均获得随访,时间6~23个月。无神经损伤加重或其他并发症,神经功能平均改善了1.1级。手术时间(102.31±16.87)min,术中失血(87.88±13.05)mL,住院时间(15.53±13.00)d,全身麻醉21例,5例局部麻醉。术后伤椎椎体前缘高度、伤椎后凸角、矢状面Cobb角与术前相比得到明显改善,差异有统计学意义(P<0.05)。末次随访时椎体高度和伤椎后凸角较术后有轻度丢失,差异无统计学意义(P>0.05);末次随访矢状面Cobb角比术后降低,差异有统计学意义(P<0.05)。VAS评分术前、术后及末次随访时逐渐降低,差异均有统计学意义P<0.05)。结论:后路经皮椎弓根螺钉附加伤椎置钉结合预弯连接棒钉棒杠杆复位内固定、椎管间接减压技术治疗伴有神经功能损伤的A3胸腰椎骨折临床效果满意,避免了椎管内直接减压,是一种安全、有效、微创的手术方式。
Objective:To explore the effectiveness of percutaneous pedicle screw fixation in injury vertebrate and curving rob indirect decompression for type A3 thoracolumbar burst fracture with neurological deficits.Methods:A retrospective study was made in 26 patients with type A3 thoracolumbar burst fracture with neurological deficits from August 2014 to July 2018 treated within 3 days after injury,which were treated with percutaneous pedicle screw fixation in injury vertebrate and curving rob indirect decompression.The radiological indexs,clinical effectiveness indexs,perioperative indexs and complication incidence were recorded and compared to observe clinical resulet.Results:All patients were followed up from 6 to 23 months.There were no nerve injury and other severe complications,which 1.1 grade of neurofunction recovery was observed at final follow-up.The average operation time was(102.31±16.87)min,with a mean intraoperative blood loss of(87.88±13.05)ml and hospital stays were(15.53±13.00)d.Local anesthesia were 5 patients and general anesthesia were 21 patients.Before the operation,the anterior height of fracture vertebral body(98.31±13.07)%、kyphotic angle(2.76±3.70)°,the Sagittal Cobb angle and(1.35±6.78)were improved to(50.19±12.32)%,(21.98±5.58)°,(16.30±8.69)°respectively after the operation(P<0.05).The anterior height of fracture vertebral body and kyphotic angle in final follow-up were worse than post-operative,but no significant difference was found between two stages(P>0.05).The Sagittal Cobb angle in final follow-up were better than those in post-operative(P<0.05).The VAS sorcer had statistical improvement(P<0.05).Conclusion:Posterior percutaneous pedicle screw fixation in injury vertebrate and curving rob indirect decompression in treating the type A3 thoracolumbar burst fracture with neurological deficits was a minimally invasive,safe and effective surgical procedur to intraspinal interference and direct decompression.
作者
祝乃强
侯静怡
马桂云
刘金欣
陈宾
ZHU Nai-qiang;HOU Jing-yi;MA Gui-yun;LIU Jin-xin;CHEN Bin(Seconde Department of Spinal Surgery,Affiliated Hospital of Chende Medical College,Chengde 067000,China;a Chengde Medical College,Chengde 067000,China)
出处
《海南医学院学报》
CAS
2019年第18期1390-1395,共6页
Journal of Hainan Medical University
基金
河北省自然科学基金(H2017406031)
国家自然科学基金(81641136,81703659)~~
关键词
经皮
神经损伤
间接减压
复位
骨折固定术
胸腰椎骨折
Percutaneous
Neurological deficit
Indirect decompression
Reduction
Fracture fixation
Thoracolumbar fracture
