Bai Guangchao, Qiu Xiaowen, Wei Guojun, Jing Xiaowei, Hu Qingfeng
Department of Orthopaedics, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China.
Sci Rep. 2025 Jan 6;15(1):877. doi: 10.1038/s41598-025-85543-9.
The purpose of this study was to present the surgical technique of Unilateral Biportal Endoscopic (UBE) decompression combined with percutaneous pedicle screws for the treatment of thoracolumbar burst fractures with secondary spinal stenosis. Thoracolumbar burst fracture is a common traumatic disease in spinal surgery. In the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification of thoracolumbar fractures, Type A fractures have the highest incidence, accounting for about 70%, with A1 and A3 types being the most common. In Type A3 fractures, there is often a displacement of fracture fragments into the spinal canal, leading to secondary spinal stenosis. The traditional approach is posterior open surgery pedicle screws combined with direct visualization for decompression, which requires extensive stripping of paravertebral muscles and resection of more bone, and is more traumatic, which is not in line with the current development concept of minimally invasive spine. The UBE technique in spinal endoscopy is currently a hot spot in the development of minimally invasive spine, and we attempted to utilize UBE decompression combined with percutaneous pedicle screws to treat thoracolumbar burst fracture with spinal stenosis, which provides a new option for the surgical treatment of thoracolumbar burst fracture with secondary spinal stenosis. We included five patients with thoracolumbar burst fractures with secondary spinal stenosis admitted to our hospital between January 2023 and January 2024, who were treated with UBE decompression combined with percutaneous pedicle screw internal fixation by our team. The degree of correction of spinal deformity was assessed using the sagittal Cobb angle and the percentage of height of the anterior margin of the vertebral body, the rate of canal encroachment was used to assess the decompression of the spinal canal, and the recovery of the patients' ability to live was assessed using the Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) Score. The results showed that the average operative length of the patients was 154.2 min, and the average intraoperative bleeding was 90 ml; the sagittal Cobb angle averaged 22.23° preoperatively, and 6.10° at 3 days postoperatively; the anterior vertebral body height ratio averaged 36.77% preoperatively, and 91.16% at 3 days postoperatively; and the residual spinal canal volume averaged 52.01% preoperatively, and 91.58% at 3 days postoperatively; VAS score averaged 7 preoperatively and 2 at 3 days postoperatively; JOA score averaged 8.4 preoperatively and 22.4 at 3 days postoperatively. UBE decompression combined with percutaneous pedicle screws is effective in the treatment of thoracolumbar burst fractures with secondary spinal stenosis and is a safe, minimally invasive surgical option for this patient population.
本研究的目的是介绍单侧双通道内镜（UBE）减压联合经皮椎弓根螺钉治疗伴继发性椎管狭窄的胸腰椎爆裂骨折的手术技术。胸腰椎爆裂骨折是脊柱外科常见的创伤性疾病。在 Arbeitsgemeinschaft für Osteosynthesefragen（AO）胸腰椎骨折分类中，A型骨折发病率最高，约占70%，其中A1和A3型最为常见。在A3型骨折中，骨折碎片常向椎管内移位，导致继发性椎管狭窄。传统的手术方法是后路开放手术，采用椎弓根螺钉并直视下减压，这需要广泛剥离椎旁肌肉并切除更多骨质，创伤较大，不符合当前微创脊柱的发展理念。脊柱内镜下的UBE技术是目前微创脊柱发展的热点，我们尝试利用UBE减压联合经皮椎弓根螺钉治疗伴椎管狭窄的胸腰椎爆裂骨折，为伴继发性椎管狭窄的胸腰椎爆裂骨折的手术治疗提供了一种新的选择。我们纳入了2023年1月至2024年1月期间我院收治的5例伴继发性椎管狭窄的胸腰椎爆裂骨折患者，由我们团队采用UBE减压联合经皮椎弓根螺钉内固定治疗。采用矢状面Cobb角和椎体前缘高度百分比评估脊柱畸形的矫正程度，采用椎管侵占率评估椎管减压情况，采用视觉模拟评分法（VAS）和日本骨科学会（JOA）评分评估患者生活能力的恢复情况。结果显示，患者平均手术时长为154.2分钟，平均术中出血量为90毫升；矢状面Cobb角术前平均为22.23°，术后3天为6.10°；椎体前缘高度比术前平均为36.77%，术后3天为91.16%；残余椎管容积术前平均为52.01%，术后3天为91.58%；VAS评分术前平均为7分，术后3天为2分；JOA评分术前平均为8.4分，术后3天为22.4分。UBE减压联合经皮椎弓根螺钉治疗伴继发性椎管狭窄的胸腰椎爆裂骨折疗效显著，是该类患者安全、微创的手术选择。
