盧 葦,楊 飛*,哈秀民,曹?chē)?guó)棟,許艷春
(1.北京大學(xué)第三醫(yī)院延慶醫(yī)院骨科,北京 102100;2.中國(guó)人民解放軍第251醫(yī)院,河北 張家口 075000)
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椎旁肌肌間隙入路聯(lián)合傷椎椎弓根螺釘內(nèi)固定治療無(wú)神經(jīng)損傷胸腰椎骨折
盧葦1,楊飛1*,哈秀民1,曹?chē)?guó)棟1,許艷春2
(1.北京大學(xué)第三醫(yī)院延慶醫(yī)院骨科,北京 102100;2.中國(guó)人民解放軍第251醫(yī)院,河北 張家口 075000)
摘要:目的觀察經(jīng)椎旁肌肌間隙入路傷椎置釘短節(jié)段椎弓根螺釘內(nèi)固定對(duì)單節(jié)段無(wú)神經(jīng)損傷胸腰椎骨折的治療效果。方法選取單節(jié)段胸腰椎骨折患者13例,采用椎旁肌間隙入路傷椎置釘短節(jié)段椎弓根螺釘內(nèi)固定治療,觀察患者術(shù)后傷椎矢狀面Cobb角、傷椎椎體前緣高度、疼痛、脊柱功能和并發(fā)癥發(fā)生情況。結(jié)果本組患者手術(shù)均順利完成,術(shù)后均獲1年隨訪,切口甲級(jí)愈合;術(shù)后傷椎矢狀面Cobb角均較術(shù)前明顯縮小,手術(shù)前后比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05);術(shù)后傷椎椎體前緣高度較術(shù)前明顯增高(P<0.05);術(shù)后VAS評(píng)分及ODI均較術(shù)前明顯下降(P<0.05)。治療過(guò)程中均無(wú)感染、內(nèi)固定松動(dòng)或斷裂等并發(fā)癥發(fā)生。結(jié)論經(jīng)椎旁肌肌間隙入路傷椎置釘短節(jié)段椎弓根螺釘內(nèi)固定能有效糾正單節(jié)段胸腰椎骨折傷椎前緣高度,糾正后凸畸形,不良反應(yīng)少。
關(guān)鍵詞:脊柱骨折;胸椎;腰椎;椎弓根螺釘;內(nèi)固定
胸腰椎是人體最大的負(fù)荷關(guān)節(jié),該節(jié)段是由相對(duì)固定的胸椎及活動(dòng)度較大的腰椎組成[1-2]。研究表明[3-4],后路椎弓根螺釘內(nèi)同定術(shù)可有效恢復(fù)受損椎體高度,術(shù)后并發(fā)癥少,是治療無(wú)神經(jīng)脊髓損傷胸腰椎骨折的有效治療方案。本研究選取我科收治的單節(jié)段無(wú)神經(jīng)損傷胸腰椎骨折患者,觀察經(jīng)椎旁肌肌間隙入路傷椎置釘短節(jié)段椎弓根螺釘內(nèi)固定對(duì)單節(jié)段無(wú)神經(jīng)損傷胸腰椎骨折的治療效果?,F(xiàn)報(bào)道如下。
1資料與方法
1.1一般資料選取2011年10月—2014年8月我科收治的單節(jié)段無(wú)神經(jīng)損傷胸腰椎骨折患者13例,男8例,女5例,年齡43~64歲,平均(45.1±2.3)歲,受傷至入院手術(shù)時(shí)間為3~10 d,平均(6.0±2.2)d。致傷原因:交通事故傷7例,高處墜落傷5例,重物砸傷1例。骨折椎體位于T123例、L18例、L22例;A1型3例、A3型2例、B1型2例、B2型3例、B3型3例,按照McCormack[1]脊柱載荷(LSD)評(píng)分為3~6分,平均(4.53±1.19)分,>7分放棄后路固定。CT檢查顯示,傷椎椎弓根雙側(cè)均完整,受損椎體椎管占位<1/3,椎體壓縮<50%,未發(fā)現(xiàn)脊髓、神經(jīng)根損傷。排除骨質(zhì)疏松癥、代謝性疾病、椎體骨密度明顯減低及合并顱腦、胸腹腔合并傷患者。
1.2手術(shù)方法本組患者均在全麻下完成手術(shù),麻醉誘導(dǎo)成功后,患者取俯臥位,常規(guī)消毒、鋪巾,C形臂X線機(jī)定位傷椎,以傷椎為中心做后正中切口,長(zhǎng)度約8~10 cm,逐層切開(kāi)皮膚及皮下組織,向兩側(cè)分離牽開(kāi)腰背肌筋膜,縱向切開(kāi)腰背肌筋膜,鈍性分離最長(zhǎng)肌與多裂肌間隙,顯露橫突基底部及關(guān)節(jié)突;在傷椎相鄰節(jié)段兩側(cè)植入椎弓根螺釘后,在傷椎椎弓根植入2枚椎弓根萬(wàn)向螺釘,壓棒過(guò)程中應(yīng)糾正脊柱后凸畸形;將受損終板較遠(yuǎn)的螺母預(yù)緊,并對(duì)上下位椎弓根釘加壓,以縮短脊柱后柱,擰緊螺母;在C形臂X線機(jī)下確認(rèn)傷椎高度恢復(fù)滿意后,關(guān)閉切口,無(wú)菌包扎。術(shù)后應(yīng)用抗生素24~48 h以預(yù)防感染,引流管于術(shù)后48~72 h拔除,并指導(dǎo)患者逐漸行腰背肌功能鍛煉;術(shù)后1周戴高腰腰圍進(jìn)行腰背肌功能鍛煉,并下床活動(dòng);術(shù)后半年內(nèi)禁止負(fù)重彎腰及劇烈活動(dòng);術(shù)后1年根據(jù)患者具體恢復(fù)情況進(jìn)行內(nèi)固定物拆除。
2結(jié)果
本組患者術(shù)前、術(shù)后隨訪數(shù)據(jù)比較,見(jiàn)表1。
表1 本組患者術(shù)前、術(shù)后隨訪數(shù)據(jù)比較±s,n=13)
注:與術(shù)前比較,#P<0.05
3結(jié)語(yǔ)
本研究中,入選患者術(shù)后傷椎矢狀面Cobb角均較術(shù)前明顯縮小(P<0.05),傷椎椎體前緣高度較術(shù)前明顯增高(P<0.05),表明經(jīng)椎旁肌肌間隙入路傷椎置釘短節(jié)段椎弓根螺釘內(nèi)固定可有效治療單節(jié)段胸腰椎骨折。在手術(shù)過(guò)程中筆者認(rèn)為應(yīng)注意傷椎植入螺釘?shù)拈L(zhǎng)度不應(yīng)超過(guò)椎體后緣骨折線,且傷椎植入螺釘?shù)奈捕丝杀认噜徆?jié)段植入的螺釘高1~2個(gè)螺紋,以便于復(fù)位時(shí)先在傷椎置釘側(cè)撐開(kāi)復(fù)位,增加金屬棒向前的頂推復(fù)位力量[5-6]。
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Paraspinal approach in combined with pedicle screw fixation treatment of thoracolumbar vertebral fracture with no nerve damage
LU Wei1,YANG Fei1*,HA Xiumin1,CAO Guodong1,XU Yanchun2
(1.Department of Orthopedics,Yanqing Hospital,The Third Hospital of Peking University,Beijing 102100,China;2.The 251st Hospital of The Chinese People’s Liberation Army,Zhangjiakou 075000,Hebei Province,China)
Abstract:ObjectiveTo observe the efficacy of paraspinal approach in combined with pedicle screw fixation in the treatment of thoracolumbar vertebral fracture with no nerve damage.MethodsA total of 13 patients with single segmental thoracolumbar vertebral fracture were treated with paraspinal approach in combined with pedicle screw fixation.The postoperative injured vertebral sagittal plane Cobb angle,the injured vertebral front edge height,pain,spinal function,and complications were observed.ResultsThe operations were successful.One-year follow up visit was paid to all the patients.The wounds were healed at the first grade.The postoperative injured vertebral sagittal plane Cobb angle was significantly lessened when compared with before operation (P<0.05).The postoperative injured vertebral front edge height was significantly increased when compared with before operation (P<0.05).The postoperative VAS score and ODI were significantly reduced when compared with before operation (P<0.05).No complications of infection,and internal fixation loosening or breaking were occurred.ConclusionThe paraspinal approach in combined with pedicle screw fixation can effectively correct the injured vertebral front edge height of single segmental thoracolumbar vertebral fracture,and rectify the kyphosis,with less adverse reactions.
Keywords:spinal fracture;thoracic vertebrae;lumbar vertebrae;pedicle screw;internal fixation
(收稿日期:2015-12-16)
文章編號(hào):2095-6258(2016)02-0358-02
中圖分類號(hào):R687.3
文獻(xiàn)標(biāo)志碼:A
*通信作者:楊飛,男,副主任醫(yī)師,電子信箱- luw1966@163.com
作者簡(jiǎn)介:盧葦(1966-),男,大學(xué)本科,副主任醫(yī)師,主要從事脊柱與關(guān)節(jié)病、四肢創(chuàng)傷研究。
基金項(xiàng)目:北京軍區(qū)醫(yī)療成果項(xiàng)目(2009229)。
DOI:10.13463/j.cnki.cczyy.2016.02.049