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微创脊柱手术治疗不稳定型胸腰椎爆裂骨折:病例系列

Minimally Invasive Spine Surgery for Unstable Thoracolumbar Burst Fractures: A Case Series.

作者信息

Agarwal Nitin, Choi Phillip A, Sekula Raymond F

机构信息

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

出版信息

Surg J (N Y). 2016 Nov 17;2(4):e131-e138. doi: 10.1055/s-0036-1594248. eCollection 2016 Oct.

Abstract

Traumatic thoracolumbar burst fracture is a common pathology without a clear consensus on best treatment approach. Minimally invasive approaches are being investigated due to potential benefits in recovery time and morbidity. We examine long-term resolution of symptoms of traumatic thoracolumbar burst fractures treated with percutaneous posterior pedicle screw fixation.  Retrospective clinical review of seven patients with spinal trauma who presented with thoracolumbar burst fracture from July 2012 to April 2013 and were treated with percutaneous pedicle screw fixation. Electronic patient charts and radiographic imaging were reviewed for initial presentation, fracture characteristics, operative treatment, and postoperative course.  The patients had a median age of 29 years (range 18 to 57), and 57% were men. The median Thoracolumbar Injury Classification and Severity Scale score was 4 (range 2 to 9). All patients had proper screw placement and uneventful postoperative courses given the severity of their individual traumas. Five of seven patients were reached for long-term follow-up of greater than 28 months. Six of seven patients had excellent pain control and stability at their last follow-up. One patient required revision surgery for noncatastrophic hardware failure.  Percutaneous pedicle screw fixation for the treatment of unstable thoracolumbar burst fracture may provide patients with durable benefits and warrants further investigation.

摘要

创伤性胸腰椎爆裂骨折是一种常见的病症,对于最佳治疗方法尚无明确的共识。由于在恢复时间和发病率方面具有潜在益处,微创方法正在研究中。我们研究经皮后路椎弓根螺钉固定治疗创伤性胸腰椎爆裂骨折的症状长期缓解情况。

对2012年7月至2013年4月期间因胸腰椎爆裂骨折就诊并接受经皮椎弓根螺钉固定治疗的7例脊柱创伤患者进行回顾性临床研究。查阅电子病历和影像学资料,了解初始表现、骨折特征、手术治疗及术后病程。

患者的中位年龄为29岁(范围18至57岁),57%为男性。胸腰椎损伤分类和严重程度评分的中位数为4(范围2至9)。鉴于个体创伤的严重程度,所有患者的螺钉置入位置均正确,术后病程平稳。7例患者中有5例获得了超过28个月的长期随访。7例患者中有6例在最后一次随访时疼痛控制良好且病情稳定。1例患者因非灾难性内固定失败需要翻修手术。

经皮椎弓根螺钉固定治疗不稳定胸腰椎爆裂骨折可能为患者带来持久益处,值得进一步研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d00b/5553496/57363b218119/10-1055-s-0036-1594248-i1600073cr-1.jpg

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