Zou Wei, Xiao Jie, Zhang Yang, Du Yuhui, Zhou Changjun
Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002,
Department of Spine Surgery, the Fourth People's Hospital of Guiyang, Guiyang Guizhou, 550002, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Jul 15;31(7):830-836. doi: 10.7507/1002-1892.201702089.
To assess the effectiveness of percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture.
Between May 2014 and February 2016, 43 cases of type A3 thoracolumbar burst fracture with or without nerve symptoms were treated with pedicle screw fixation and neural decompression. Of them, 21 patients underwent percutaneous pedicle screw fixation and minimally invasive decompression in the same incision (percutaneous group), and the other 22 patients underwent traditional open surgery (open group). There was no significant difference in gender, age, cause of injury, fractures level, preoperative American Spinal Injury Association (ASIA) grade, thoracolumbar injury classification and severity (TLICS) score, load-sharing classification, height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment between 2 groups ( >0.05). The length of soft tissue dissection, operation time, intraoperative blood loss, postoperative drainage, X-ray exposure times, and incision visual analogue scale (VAS) score at 1 day after operation were recorded and compared. At last follow-up, Japanese Orthopaedic Association (JOA) score and low back pain VAS score were recorded and compared respectively. The ASIA grade recovery was evaluated; the height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment were assessed postoperatively.
Percutaneous group was significantly better than open group in the length of soft tissue dissection, intraoperative blood loss, postoperative drainage, and incision VAS at 1 day after operation ( <0.05), but no significant difference was found in operation time between 2 groups ( >0.05); however, X-ray exposure times of open group were significantly better than that of percutaneous group ( <0.01). The patients were followed up 12 to 19 months (mean, 15.1 months) in 2 groups. All patients achieved effective decompression. No complications of iatrogenic neurological injury and internal fixation failure occurred. The height of injury vertebrae, kyphotic Cobb angle, and spinal canal encroachment of the fractured vertebral body were significantly improved at 3 days after operation when compared with preoperative ones ( <0.05), but no significant difference was found between 2 groups ( >0.05). At last follow-up, JOA score and low back pain VAS score of percutaneous group were significantly better than those of open group ( <0.05). The neurological function under grade E was improved at least one ASIA grade in 2 groups, but no significant difference was shown between 2 groups ( =0.480, =0.961).
Percutaneous pedicle screw fixation and minimally invasive decompression in the same incision for type A3 thoracolumbar burst fracture has satisfactory effectiveness. And it has the advantages of minimal trauma, quick recovery, safeness, and reliableness.
评估经皮椎弓根螺钉固定与在同一切口行微创减压治疗A3型胸腰椎爆裂骨折的疗效。
2014年5月至2016年2月，对43例伴有或不伴有神经症状的A3型胸腰椎爆裂骨折患者行椎弓根螺钉固定及神经减压术。其中，21例患者接受经皮椎弓根螺钉固定并在同一切口行微创减压术（经皮组），另外22例患者接受传统开放手术（开放组）。两组患者在性别、年龄、受伤原因、骨折节段、术前美国脊髓损伤协会（ASIA）分级、胸腰椎损伤分类及严重程度（TLICS）评分、载荷分担分类、伤椎高度、后凸Cobb角及椎管侵占率方面比较，差异均无统计学意义（P>0.05）。记录并比较两组患者的软组织剥离长度、手术时间、术中出血量、术后引流量、X线透视次数及术后1天切口视觉模拟评分（VAS）。末次随访时，分别记录并比较两组患者的日本骨科学会（JOA）评分及腰痛VAS评分。评估ASIA分级恢复情况；术后评估伤椎高度、后凸Cobb角及椎管侵占率。
经皮组在软组织剥离长度、术中出血量、术后引流量及术后1天切口VAS方面均显著优于开放组（P<0.05），但两组手术时间比较，差异无统计学意义（P>0.05）；然而，开放组X线透视次数显著优于经皮组（P<0.01）。两组患者随访12～19个月（平均15.1个月）。所有患者均获得有效减压。未发生医源性神经损伤及内固定失败等并发症。术后3天伤椎高度、后凸Cobb角及骨折椎体椎管侵占率与术前比较均显著改善（P<0.05），但两组间比较差异无统计学意义（P>0.05）。末次随访时，经皮组JOA评分及腰痛VAS评分均显著优于开放组（P<0.05）。两组E级以下神经功能均至少提高一个ASIA分级，但两组间比较差异无统计学意义（P=0.480，P=0.961）。
经皮椎弓根螺钉固定并在同一切口行微创减压治疗A3型胸腰椎爆裂骨折疗效满意。具有创伤小、恢复快、安全可靠等优点。
