经皮椎弓根螺钉内固定修复单节段胸腰椎骨折：活动度改善12个月随访

摘要

背景：研究表明经皮椎弓根螺钉置入内固定修复单节段胸腰段脊柱骨折可以克服四边形效应，获得更好的生物力学性能，同时可提供三点固定，降低悬挂效应，减少后凸的形成。目的：观察经皮椎弓根螺钉置入内固定修复单节段胸腰段脊柱骨折的临床疗效及并发症发生率。方法：收集经皮椎弓根螺钉置入内固定修复单节段胸腰段骨折的患者36例，共36个治疗椎体：T11=5， T12=8，L1=17，L2=6。对比观察治疗前及治疗后3，6，12个月的目测类比评分，治疗前及治疗后1周、12个月的Oswestry功能障碍指数，治疗前及治疗后1 d、治疗后12月的Cobb角，并记录并发症发生率。结果与结论：治疗后3，6，12个月的目测类比评分显著低于治疗前(P <0.001)；治疗后1周、12个月的Oswestry功能障碍指数显著低于治疗前(P <0.001)；治疗后1 d及12个月Cobb角显著小于治疗前(P <0.001)。仅3例(8%)患者出现并发症，包括椎弓根螺钉穿透椎弓根进入椎管、椎弓根螺钉松动及穿刺部位感染。提示经皮椎弓根螺钉置入内固定修复单节段胸腰段脊柱骨折可矫正后凸畸形，改善胸腰段活动度，快速缓解患者腰背部疼痛，且并发症发生率低。%BACKGROUND:Studies have shown that percutaneous pedicle screw internal fixation in repair of single segment of thoracolumbar fracture can overcome quadrilateral effect, get better biomechanical properties, meanwhile, it also can provide three-point fixation, reduce suspension effect, and reduce the formation of kyphosis. OBJECTIVE: To investigate the clinical efficacy and incidence of complications of the percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures. METHODS:Totaly 36 patients with single segment thoracolumbar fractures treated by percutaneous pedicle screw internal fixation were enroled. A total of 36 vertebral bodies were treated: T11=5, T12=8, L1=17, L2=6. The visual analog scale scores before treatment and at 3, 6 and 12 months after treatment, the Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment, the Cobb angle before treatment, the first day and at the 12th month after treatment were compared and observed. The incidence of complications was recorded. RESULTS AND CONCLUSION:The visual analog scale scores at 3, 6 and 12 months after treatment was significantly lower than those before treatment (P < 0.001). The Oswestry disability indexes before treatment, at the first week and at the 12th month after treatment were significantly lower those that before treatment (P < 0.001).The Cobb angle before treatment, at the first day and at the 12th month after treatment was significantly smaler than that before treatment (P < 0.001). Only three (8%) patients had complications, including pedicle screw penetrating pedicle into the spinal canal, pedicle screws loosing and the infection in puncture site. These results suggest that percutaneous pedicle screw internal fixation for treatment of single segment thoracolumbar fractures can correct kyphosis, improve the thoracolumbar motion, quickly relieve patient’s back pain, and the incidence of complications is low.