Kang Hui, Xu Feng, Xiong Chengjie, Xi Jintao, Wu Boyu
Department of Orthopaedics, Central Theater Command General Hospital of PLA, Wuhan Hubei, 430070, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Mar 15;34(3):308-312. doi: 10.7507/1002-1892.201904140.
To evaluate the effectiveness of percutaneous monoplanar screw internal fixation via injured vertebrae for treatment of thoracolumbar fracture.
Between May 2015 and August 2017, 38 cases of thoracolumbar fractures without neurological symptom were treated with percutaneous monoplanar screw internal fixation via injured vertebrae. There were 22 males and 16 females, aged 25-52 years (mean, 32.5 years). There were 23 cases of AO type A3 and 15 cases of AO type A4. The injured vertebrae located at T in 4 cases, T in 9 cases, L in 11 cases, L in 10 cases, L in 3 cases, and L in 1 case. The mean interval between injury and operation was 4.5 days (range, 3-7 days). The pre- and post-operative degrees of lumbodorsal pain were estimated by the visual analogue scale (VAS) score. The X-ray film, CT three-dimensional reconstruction, and MRI were performed, and the ratio of anterior vertebral body height and sagittal Cobb angle were measured to assess the kyphosis of the fractured area.
All operations in 38 patients successfully completed without complications such as dural sac, nerve root, or vascular injury. The operation time was (56.2±3.7) minutes and the intraoperative blood loss was (42.3±3.5) mL. All incisions healed by first intention without redness, swelling, or exudation. All patients were followed up 17-33 months, with an average of 21.5 months. The VAS score at each time point after operation significantly improved when compared with that before operation ( <0.05), and significantly improved at 3 months and last follow-up when compared with that at 1 week ( <0.05); there was no significant difference between 3 months and last follow-up ( >0.05). There was no internal fixator loosening, breakage, or delayed kyphosis in all patients. The ratio of anterior vertebral body height and sagittal Cobb angle significantly improved postoperatively ( <0.05), and no significant difference was found between the different time points after operation ( >0.05).
Percutaneous monoplanar screw internal fixation via injured vertebrae is an easy approach to treat thoracolumbar fracture without neurological symptom, which can effectively restore vertebral body height and correct kyphosis, and avoid long-term segmental kyphosis.
评估经伤椎单平面螺钉内固定治疗胸腰椎骨折的有效性。
2015年5月至2017年8月，对38例无神经症状的胸腰椎骨折患者采用经伤椎单平面螺钉内固定治疗。其中男性22例，女性16例，年龄25 - 52岁（平均32.5岁）。AO分型中A3型23例，A4型15例。伤椎位于T12 4例，T1 9例，L1 11例，L2 10例，L3 3例，L4 1例。受伤至手术的平均间隔时间为4.5天（范围3 - 7天）。采用视觉模拟评分法（VAS）评估术前及术后腰背部疼痛程度。行X线片、CT三维重建及MRI检查，测量椎体前缘高度比值及矢状面Cobb角，以评估骨折区域后凸畸形情况。
38例患者手术均顺利完成，未发生硬脊膜囊、神经根或血管损伤等并发症。手术时间为（56.2±3.7）分钟，术中出血量为（42.3±3.5）mL。所有切口均一期愈合，无红肿、渗液。所有患者均获随访，随访时间17 - 33个月，平均21.5个月。术后各时间点VAS评分与术前比较均显著改善（P<0.05），与术后1周比较，术后3个月及末次随访时均显著改善（P<0.05）；术后3个月与末次随访时比较差异无统计学意义（P>0.05）。所有患者均未出现内固定物松动、断裂或迟发性后凸畸形。术后椎体前缘高度比值及矢状面Cobb角均显著改善（P<0.05），术后不同时间点比较差异无统计学意义（P>0.05）。
经伤椎单平面螺钉内固定是治疗无神经症状胸腰椎骨折的一种简便方法，能有效恢复椎体高度、矫正后凸畸形，避免远期节段性后凸畸形。
