Wang Yuanyi, Ning Cong, Yao Liyu, Huang Xiuying, Zhao Chengliang, Chen Bin, Zhang Nan
aThe First Hospital of Jilin University, Jilin bThe Hospital of Chengde Medical College, Hebei, China.
Medicine (Baltimore). 2017 Nov;96(46):e8640. doi: 10.1097/MD.0000000000008640.
Lumbar burst fractures are frequent injury resulting from high-energy trauma, and the patients suffer from pain and the neurologic dysfunction. Although minimally invasive techniques have advanced rapidly, it was the first time to apply transforaminal endoscopic combined with percutaneous pedicle screw fixation to treatment of lumbar burst fractures.
A 33-year-old man underwent Magerl type A3.1 burst fracture at L2 and compression fractures at L3 due to falling from a height with severe lower back pain, sensory loss, and atony of the right leg.
Burst fracture at L2, compression fractures at L3.
The patient was presented to 1-stage operation of percutaneous pedicle screw fixation at L1, L2, L3, and L4 instead of delayed posterior open surgery. At 1 week after injury, the 2-stage operation with a percutaneous transforaminal endoscopic was undertaken for decompression.
No matter the function of nerve and imaging findings, all got ideal recoveries in just 3 days after 2-stage operation. At the 3-month follow-up, there was no loss of sagittal plane alignment, and spinal cord compression was completely relieved. The patient regained near-full neurologic function postoperatively.
A minimally invasive surgery (ie, transforaminal endoscopic combined with percutaneous pedicle screw fixation) for the treatment of Magerl type A3.1 burst fracture at lumbar was feasible. In addition, the key to the recovery of neurological function is the complete and effective decompression of spinal.
腰椎爆裂骨折是高能创伤导致的常见损伤，患者会遭受疼痛和神经功能障碍。尽管微创技术发展迅速，但经椎间孔内镜联合经皮椎弓根螺钉固定术首次应用于腰椎爆裂骨折的治疗。
一名33岁男性因高处坠落致L2椎体Magerl A3.1型爆裂骨折及L3椎体压缩骨折，伴有严重下腰痛、感觉丧失及右下肢肌力减弱。
L2椎体爆裂骨折，L3椎体压缩骨折。
患者接受了L1、L2、L3和L4椎体经皮椎弓根螺钉固定一期手术，而非延迟后路开放手术。受伤1周后，进行了经皮椎间孔内镜二期减压手术。
二期手术后仅3天，神经功能和影像学表现均恢复理想。3个月随访时，矢状面排列无丢失，脊髓压迫完全解除。患者术后神经功能几乎完全恢复。
微创外科手术（即经椎间孔内镜联合经皮椎弓根螺钉固定术）治疗腰椎Magerl A3.1型爆裂骨折是可行的。此外，神经功能恢复的关键是脊髓的完全有效减压。
