微创经皮椎弓根螺钉内固定治疗强直性脊柱炎合并胸腰椎骨折的疗效

摘要

Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.%目的 探讨微创经皮椎弓根螺钉内固定技术治疗强直性脊柱炎(AS)合并胸腰椎骨折的临床疗效. 方法 采用回顾性病例系列研究分析2013年1月-2016年1月收治的12例AS合并胸腰椎骨折患者临床资料,其中男9例,女3例;年龄24 ～63岁[(42.7±13.0)岁].均采用后路微创经皮椎弓根螺钉内固定.记录手术时间、术中出血量、切口长度、下地时间、恢复生活时间等指标.术前、术后采用腰背痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价功能恢复情况.观察骨折愈合及并发症情况. 结果 患者均获随访14 ～ 36个月,平均22个月.患者均顺利完成手术.手术时间和术中出血量分别为(178.0±60.2)min和(116.7±44.2)ml.手术切口为1.2～1.5 cm.术中均未发生血管、神经损伤等严重并发症.术后2～3d疼痛明显缓解,均在支具保护下实现下地活动.恢复生活时间为术后(23.4±7.3)d.术后1,3,6,12个月,VAS和ODI均较术前明显改善(P＜0.05).所有患者骨折获得临床骨性愈合.随访期间未发生螺钉松动或内固定失效. 结论 微创经皮椎弓根螺钉内固定治疗AS合并胸腰椎骨折,手术创伤小、出血少,术后下地时间早,骨折愈合好.