Objective:To explore the feasibility and effect of percutanuous cannulated pedicle screw AF system fixation for the treatment of thoracolumbar flexion - distraction fracture without neurologic impairment. Methods: From June 2008 to June 2010,21 patients with thoracolumbar flexion-distraction fracture were treated with percutanuous cannulated pedicle screw fixation. There were 16 males and 5 females with the mean age of 32.7 years ranging from 23 to 55 years. Injured levels 5 cases was in T12,13 was in L1;3 was in L;. According to classification of AO,B1 was in 13 cases,B2 was in 8 cases. ASIA grade of all the patients were grade E. The mean operative time, bleeding volume, lengths of stay were evaluated. All the patients took the X -ray and three-dimensional CT reconstruction to observe the fracture healing and to measure the height of the anterior border of fracture vertebral body and the Cobb angle of kyphosis. The visual analogue scales (VAS) were compared preoperation and postoperation. The clinical effects were analyzed according to Oswestry Disability Index (ODI) from 10 aspects,including pain intensity .personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, traveling. Results-.All the operations were successful and the mean time was (109.0±16.0) min,blood loss was (90.0±15.0) ml,lengths of stay was (7.7±2.3) d. No postoperative neurological deficits or wound infection occurred. One case occurred subcutaneous fluid of incision and 1 case occurred delayed healing of incision. Fifteen patients were followed up with an average of 16.7 months (12-33 months). The VAS score improved from preoperative 8.3±1.7 to 1.8±1.2 at final follow up (P<0.05). The ODI of last follow-up was (10.0± 1.2)%. Three-dimensional CT reconstructions and X-rays showed the height of vertebra] body increased from preoperative (54.0±17.1)% to (82.7 ± 3.5)% at 12 months after operation (P<0.05). Cobb angle of kyphosis changed from preoperative (23.0±13.1)° to (6.9±5.1)°at 12 months after operation (P<0.05). The healing time of fracture was (4.7±0.3) months. There were no significant loss of vertebral height or kyphosis correction between postoperative 1 months and last follow-up (P>0.05).There were satisfactory fracture reduction and good position of internal fixation, and no loss of reduction within 12 months and no fixation failure in follow-up. Conclusion: The minimally invasive percutaneous cannulated pedicle screw fixation technique is feasible in treatment of thoracolumbar flexion-distraction fracture without neurologic impairment. This technique can avoid re -injury of posterior ligaments and bone structure, and may rebuild posterior tension band structure with the advantages of less trauma, less bleeding, shorter operative time, rapid postoperative recovery and so on.%目的:探讨微创经皮空心AF椎弓根固定系统治疗无神经功能障碍的屈曲牵张型胸腰椎骨折的可行性及疗效.方法:回顾分析2008年6月至2010年6月使用经皮空心椎弓根固定系统治疗的21例无神经功能障碍的屈曲牵张型胸腰椎骨折患者临床资料,男16例,女5例,年龄23～55岁,平均32.7岁.损伤节段:T12 5例,L1 13例,L2 3例.所有病例ASIA分级为E级.AO分型:BI型13例,B2型8例.评估内容:平均手术时间、手术出血量、住院时间;通过X线片及CT三维重建,测量椎体前缘高度及后凸角度,观察骨折愈合情况;比较手术前后患者VAS评分,采用ODI评分从疼痛程度、日常生活自理能力、提物、行走、坐、站立、睡眠、性生活、社会活动、郊游等10个方面对疗效进行评定.结果:21例患者手术顺利,平均手术时间(109.0±16.0)min,术中出血量(90.0±15.0)ml,住院时间(7.7±2.3)d.术后无神经功能障碍及切口感染,切口皮下积液1例,切口延迟愈合1例.其中15例获得1年以上随访,平均随访时间16.7个月(12～33个月).VAS评分由术前(8.3±1.7)分降低为末次随访时的(1.8±1.2)分(P<0.05),末次随访时ODI为(10.0±1.2)%;伤椎高度由术前(54.0±17.1)%恢复至术后12个月的(82.7±3.5)%(P<0.05),胸腰段后凸崎形由术前(23.0±13.1)°恢复至术后12个月的(6.9±5.1)°(P<0.05);骨折平均愈合时间为(4.7±0.3)个月;术后1个月随访和末次随访相比椎体高度和后凸矫正无明显丢失(P>0.05).故骨折复位满意,内固定位置良好,12月内无复位丢失.随访期间无内固定失败病例.结论:微创经皮空心椎弓根螺钉内固定技术治疗无神经功能障碍的屈曲牵张型胸腰段骨折是可行的.这个技术能够避免对后方韧带和骨性结构的再损伤,并可重建后方张力带结构,具有创伤小、出血少、手术时间短、术后恢复快等优点.
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