单纯微创椎弓根钉内固定技术治疗胸腰椎爆裂骨折的中期疗效研究

目的　评价微创椎弓根钉内固定技术治疗胸腰椎爆裂骨折的中期临床疗效。方法　2002年9月－2007年9月，采用微创椎弓根钉内固定技术治疗胸腰椎爆裂骨折30例。其中男16例，女14例;年龄18～65岁，平均39.8岁。骨折节段胸11者3例，胸12者13例，腰1者12例，腰者22例。所有骨折按AO分型，均为A3型。受伤至手术时间6h～6d，平均45h。分析术后影像学指标、疼痛评分及功能障碍指数。结果　患者均获随访，随访时间3～9年，平均5.2年。术后各时间点伤椎前缘高度及后凸Cobb角均较术前明显恢复（P＜0.01）。术后伤椎高度随随访时间延长逐渐下降，后凸Cobb角逐渐增大。取出内固定物后、术后2年、末次随访时动力位X线片上骨折椎体前后相对滑移距离分别为（1.9±0.3）、（2.1±0.2）、（2.1±0.3）mm，两两比较差异无统计学意义（P＞0.05）。术后1、2年及末次随访时疼痛视觉模拟评分分别为（2.5±1.2）、（2.5±1.1）、（2.4±1.3）分，两两比较差异无统计学意义（P＞0.05）。末次随访时Denis腰痛分级P1级13例，P2级12例，P3级5例。功能障碍指数为（11.4±3.1）分，获优23例、良5例、可2例。结论　单纯微创椎弓根钉内固定技术治疗胸腰椎爆裂骨折中期临床效果满意，脊柱稳定性良好。Objective　Tomid-termefficacyofthetechniqueofminimallyinvasivepediclescrewfixationonthoracolumbarburstfracture.Methods　FromSeptember2002toSeptember2007,30patientsweretreatedwithminimallyinvasivepediclescrewfixationforthoracolumbarfracture.Therewere16malesand14femaleswiththemeanageof39.8years(range,18-65years).TheinjuredlevelofwasT11in3cases,T12in13cases,L1in12cases,andL2in2cases.ThetypeofthoracolumbarfracturesofallthepatientswasA3accordingtoAOclassification.Theduringfrominjurytooperationwas6hoursto6dayswithanaverageof45hours.Theindexofimageandpainanddisabilityindexwereevaluatedafteroperation.Results　Allpatientswerefollowedupfor3to9yearswiththemeanof5.2years.Theiraverageslidingdistanceafteroperationforremovinginternalfixationwas(1.9±0.3),and(2.1±0.2)mm2yearsaftertheoperationand(2.1±0.3)mmatthelatestfollow-up.Therewasnosignificantdifference(P＞0.05).Theiraveragescorewas(2.51±1.2)1yearaftertheoperation,was(2.42±1.1)2yearaftertheoperation,andwas(2.36±1.3)atthelatestfollow-up(P＞0.05).AccordingtoDenisscoresystemtoevaluateindexoflumbago,therewasP1in13cases,P2in12cases,andP3in5cases.ThescoreofOswestryDisabilityIndex(ODI)was11.4±3.1atthelatestfollow-up.Twenty-onecasesgotexcellenttherapeuticresult,fivecasesgotgoodandtwoweremoderate.Conclusions　Minimallyinvasivepediclescrewfixationforthetreatmentofthoracolumbarburstfractureprovidesatisfactoryclinicalresults.Thevertebralbodyandadjacentvertebralbodyhaveagoodstability.