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经皮椎弓根螺钉固定治疗脊柱创伤和肿瘤的疗效

Outcomes of percutaneous pedicle screw fixation for spinal trauma and tumours.

作者信息

Mobbs Ralph J, Park Ashley, Maharaj Monish, Phan Kevin

机构信息

NeuroSpineClinic, Suite 7, Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, NSW 2031, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; NeuroSpine Surgery Research Group, Sydney, NSW, Australia.

Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.

出版信息

J Clin Neurosci. 2016 Jan;23:88-94. doi: 10.1016/j.jocn.2015.05.046. Epub 2015 Sep 28.

Abstract

We investigated the clinical and radiological results of percutaneous pedicle screw fixation in the management of spinal trauma and metastatic tumours. A retrospective analysis was performed on a series of 14 patients who were operated on from March 2009 to November 2011 by a single surgeon (RJM). Following a radiological review (CT scan/MRI), six patients underwent short segment fixation, while the remaining underwent long segment fixation. All patients had routine follow-ups at 4, 6, 12months, and annually thereafter. Clinical examinations were conducted preoperatively and postoperatively, and the length of operation, blood loss, and postoperative pain relief were recorded. There was a single patient with an incision site complication. The mean blood loss was 269mL. All of the parameters demonstrated no significant differences between the trauma and the tumour groups (p=0.10). The neurological power scores improved for all patients, with the largest increase being from a score of 2 to 4. At follow-up, the majority of patients had returned to their previous activities and had reduced pain scores. One patient suffered high pain levels from other medical conditions that were not related to the operation. Minimally invasive pedicle screw fixation is a suitable option for patients with spinal tumours and fractures, with acceptable safety and efficacy in this small retrospective patient series. We have seen favourable results in our patients, who have experienced an increased quality of life following their surgery.

摘要

我们研究了经皮椎弓根螺钉固定术在脊柱创伤和转移性肿瘤治疗中的临床及影像学结果。对2009年3月至2011年11月间由同一外科医生(RJM)手术治疗的14例患者进行回顾性分析。经影像学检查(CT扫描/MRI)后,6例患者接受短节段固定,其余患者接受长节段固定。所有患者在术后4、6、12个月进行常规随访,此后每年随访一次。术前和术后进行临床检查,并记录手术时间、失血量和术后疼痛缓解情况。有1例患者出现切口部位并发症。平均失血量为269mL。所有参数在创伤组和肿瘤组之间均无显著差异(p = 0.10)。所有患者的神经功能评分均有改善,最大提升是从2分提高到4分。随访时,大多数患者已恢复之前的活动,疼痛评分降低。1例患者因与手术无关的其他疾病而疼痛程度较高。在这个小型回顾性患者系列中,微创椎弓根螺钉固定术对于脊柱肿瘤和骨折患者是一种合适的选择,具有可接受的安全性和疗效。我们的患者取得了良好的结果,术后生活质量有所提高。

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