体位复位结合经皮微创椎弓根螺钉撑开复位内固定治疗无神经症状的单节段胸腰椎爆裂骨折
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摘要
目的探讨体位复位结合经皮微创椎弓根螺钉撑开复位内固定在无神经症状的胸腰椎爆裂骨折治疗中的应用及其临床疗效。方法回顾性分析2015年1月至8月收治的无神经症状的单节段胸腰椎爆裂骨折患者57例的临床资料,其中采用体位复位结合经皮微创椎弓根螺钉撑开复位内固定27例(微创组)和后路切开复位内固定30例(切开组)。比较两组手术时间、术中出血量、术后引流量;术后1 d、12个月的视觉模拟评分(VAS);术前、术后12个月随访时椎体前缘高度百分比及后凸Cobb角的情况。结果两组患者年龄、性别、受伤部位、受伤原因、受伤至手术时间比较无统计学差异(P均> 0. 05),患者均获12个月随访。微创组患者手术时间、术中出血量、术后1 d引流量和术后1 d、12个月VAS评分显著优于切开组(P <0. 05,P <0. 01);两组患者术后3 d、12个月时的Cobb角、椎体前缘高度百分比均较术前明显改善(P均<0. 01),但组间比较无统计学差异(P均> 0. 05);微创组术中X线暴露次数显著多于切开组(P <0. 01)。结论与切开复位内固定相比较,体位复位结合经皮微创椎弓根螺钉撑开复位内固定技术具有创伤小、操作简便及术后恢复快等优点,是治疗无神经症状的单节段胸腰椎爆裂骨折安全有效的方法,但应关注X线暴露次数对患者及术者带来的伤害。
Objective To investigate the clinical effect of postural reduction and minimally invasive percutaneous pedicle screws internal fixation for thoracolumbar vertebral burst fractures without neurological symptoms. Methods A retrospective analysis was performed in 57 patients with single-level thoracolumbar burst fractures without neurological symptoms from January to August 2015,in whom postural reduction combined with percutaneous minimally invasive pedicle screw internal fixation was conducted in 27 cases(minimally invasive group),and posterior open reduction and internal fixation was conducted in 30 cases(open group). The operation time,intraoperative bleeding volume,postoperative drainage volume,visual analogue scale(VAS) at 1 day and 12 months after operation,the percentage of anterior vertebral height and Cobb angle of kyphosis before operation and post-operative 12-month follow-up were compared between two groups. Results There were no significant differences between two groups in age,sex,location and cause of injury,time between injury and surgery(all P > 0. 05). All patients were followed up for 12 months. Compared with open group,the operation time,intraoperative bleeding volume,drainage volume on the postoperative first day significantly decreased in minimally invasive group,and VAS score on the first day and 12 months after operation were significantly better than those in control group(P< 0. 05,P < 0. 01). The Cobb angle and the percentage of anterior vertebral height were significantly improved 3 days and12 months after operation,but there were no significant differences between the two groups,and X-ray exposure times in minimally invasive group were significantly higher than those in open group(P < 0. 01). Conclusion Compared with open reduction and internal fixation,postural reduction combined with percutaneous minimally invasive pedicle screw internal fixation is a safe and effective method for the treatment of single-segment thoracolumbar burst fractures without neurological symptoms,but attention should be paid to the harm of X-ray exposure to patients and surgeons.
Objective To investigate the clinical effect of postural reduction and minimally invasive percutaneous pedicle screws internal fixation for thoracolumbar vertebral burst fractures without neurological symptoms. Methods A retrospective analysis was performed in 57 patients with single-level thoracolumbar burst fractures without neurological symptoms from January to August 2015,in whom postural reduction combined with percutaneous minimally invasive pedicle screw internal fixation was conducted in 27 cases(minimally invasive group),and posterior open reduction and internal fixation was conducted in 30 cases(open group). The operation time,intraoperative bleeding volume,postoperative drainage volume,visual analogue scale(VAS) at 1 day and 12 months after operation,the percentage of anterior vertebral height and Cobb angle of kyphosis before operation and post-operative 12-month follow-up were compared between two groups. Results There were no significant differences between two groups in age,sex,location and cause of injury,time between injury and surgery(all P > 0. 05). All patients were followed up for 12 months. Compared with open group,the operation time,intraoperative bleeding volume,drainage volume on the postoperative first day significantly decreased in minimally invasive group,and VAS score on the first day and 12 months after operation were significantly better than those in control group(P< 0. 05,P < 0. 01). The Cobb angle and the percentage of anterior vertebral height were significantly improved 3 days and12 months after operation,but there were no significant differences between the two groups,and X-ray exposure times in minimally invasive group were significantly higher than those in open group(P < 0. 01). Conclusion Compared with open reduction and internal fixation,postural reduction combined with percutaneous minimally invasive pedicle screw internal fixation is a safe and effective method for the treatment of single-segment thoracolumbar burst fractures without neurological symptoms,but attention should be paid to the harm of X-ray exposure to patients and surgeons.
引文
[1]艾克帕尔·吾不利,买买艾力·玉山.微创脊柱内固定系统治疗无神经损伤胸腰椎骨折的临床疗效分析[J].中国临床研究,2017,30(5):649-651.
[2] Mikles MR,Stchur RP,Graziano GP. Posterior instrumentation for thoracolumbar fractures[J]. J Am Acad Orthop Surg,2004,12(6):424-435.
[3]杨杰,翁润民,胡景阳,等.经皮经单侧伤椎椎弓根螺钉内固定术治疗胸腰椎骨折的效果[J].中国临床研究,2018,31(5):666-669.
[4] Taylor H,Mc Gregor AH,Medhi-Zadeh S,et al. The impact of self-retaining retractors on the paraspinal muscles during posrerior spinal surgery[J]. Spine(Phila Pa 1976),2002,27(24):2758-2762.
[5] Defino HLA,Canto FR. Low thoracic and lumbar burst fractures:radio:graphic and functional outcomes[J]. Eur Spine J,2007,16:1934-1943.
[6] Wood KB,Li W,Lebl DR,et al. Management of thoracolumbar spine fractures[J]. Spine J,2014,14(1):145-164.
[7] Han GQ,He C,Shao LQ. Analysis on curative effect of percutaneous minimally invasive spinal internal fixation with pedicle screw rod system for thoracolumbar fracture[J]. Biomedical Research,2017,28(15):6848-6851.
[8] Konstantinidis L,Mayer E,Strohm PC,et al. Early surgery-related omplications after anteroposterior stabilization of vertebral body fractures in the thoracolumbar region[J]. J Orthop Sci,2010,15(2):178-184.
[9] Yang WR,Ng ZX,Koh KM,et al. Pereutaneous pedicle screw fixation for thoracolumbar burst fracture:a Singapore experience[J].Singapore Med J,2012,53(9):577-581.
[10]刘继军,王欣文,郝定均,等.微创自撑开钉与开放椎弓根螺钉内固定治疗胸腰椎骨折的疗效比较[J].中华创伤骨科杂志,2014,16(3):208-211.
[11]王文涛,段琨,王欣文,等.体位复位经皮微创椎弓根螺钉内固定治疗无神经症状的胸腰椎重度压缩骨折[J].骨科,2017,8(1):34-38.
[12] Wang ST,Ma HL,Liu CL,et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine? A prospecfive,randomized study[J]. Spine(Phila Pa 1976),2006,31:2646-2653.
[13]谢鹏,贺西京,吕游,等.微创经皮入路对无神经症状胸腰椎爆裂性骨折的有效性和安全性研究[J].中国医学前沿杂志(电子版),2017,9(3):120-123.
[14] Merom L,Raz N,Hamud C,et al. Minimally invasive burst fracture fixation in the thoracolumbar region[J]. Orthopedics,2009,32(4):273-278.
[15] Rechtine GR,Bono PL,Cahill D,et al. Postoperative wound infection after instrumentation of thoracic and lumbar fractures[J]. J Orthop Trauma,2001,15(8):566-569.
[16] Kim DY,Lee SH,Chung SK,et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J]. Spine(Phila Pa 1976),2005,30(1):123-129.
[17] Rampersaud NA,Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma:current concepts[J]. Spine(Phila Pa 1976),2006,31(11):96-102.
[2] Mikles MR,Stchur RP,Graziano GP. Posterior instrumentation for thoracolumbar fractures[J]. J Am Acad Orthop Surg,2004,12(6):424-435.
[3]杨杰,翁润民,胡景阳,等.经皮经单侧伤椎椎弓根螺钉内固定术治疗胸腰椎骨折的效果[J].中国临床研究,2018,31(5):666-669.
[4] Taylor H,Mc Gregor AH,Medhi-Zadeh S,et al. The impact of self-retaining retractors on the paraspinal muscles during posrerior spinal surgery[J]. Spine(Phila Pa 1976),2002,27(24):2758-2762.
[5] Defino HLA,Canto FR. Low thoracic and lumbar burst fractures:radio:graphic and functional outcomes[J]. Eur Spine J,2007,16:1934-1943.
[6] Wood KB,Li W,Lebl DR,et al. Management of thoracolumbar spine fractures[J]. Spine J,2014,14(1):145-164.
[7] Han GQ,He C,Shao LQ. Analysis on curative effect of percutaneous minimally invasive spinal internal fixation with pedicle screw rod system for thoracolumbar fracture[J]. Biomedical Research,2017,28(15):6848-6851.
[8] Konstantinidis L,Mayer E,Strohm PC,et al. Early surgery-related omplications after anteroposterior stabilization of vertebral body fractures in the thoracolumbar region[J]. J Orthop Sci,2010,15(2):178-184.
[9] Yang WR,Ng ZX,Koh KM,et al. Pereutaneous pedicle screw fixation for thoracolumbar burst fracture:a Singapore experience[J].Singapore Med J,2012,53(9):577-581.
[10]刘继军,王欣文,郝定均,等.微创自撑开钉与开放椎弓根螺钉内固定治疗胸腰椎骨折的疗效比较[J].中华创伤骨科杂志,2014,16(3):208-211.
[11]王文涛,段琨,王欣文,等.体位复位经皮微创椎弓根螺钉内固定治疗无神经症状的胸腰椎重度压缩骨折[J].骨科,2017,8(1):34-38.
[12] Wang ST,Ma HL,Liu CL,et al. Is fusion necessary for surgically treated burst fractures of the thoracolumbar and lumbar spine? A prospecfive,randomized study[J]. Spine(Phila Pa 1976),2006,31:2646-2653.
[13]谢鹏,贺西京,吕游,等.微创经皮入路对无神经症状胸腰椎爆裂性骨折的有效性和安全性研究[J].中国医学前沿杂志(电子版),2017,9(3):120-123.
[14] Merom L,Raz N,Hamud C,et al. Minimally invasive burst fracture fixation in the thoracolumbar region[J]. Orthopedics,2009,32(4):273-278.
[15] Rechtine GR,Bono PL,Cahill D,et al. Postoperative wound infection after instrumentation of thoracic and lumbar fractures[J]. J Orthop Trauma,2001,15(8):566-569.
[16] Kim DY,Lee SH,Chung SK,et al. Comparison of multifidus muscle atrophy and trunk extension muscle strength:percutaneous versus open pedicle screw fixation[J]. Spine(Phila Pa 1976),2005,30(1):123-129.
[17] Rampersaud NA,Dekutoski MB. Use of minimally invasive surgical techniques in the management of thoracolumbar trauma:current concepts[J]. Spine(Phila Pa 1976),2006,31(11):96-102.