| 宋鑫,张锋,韩帅,任东林,王健*.后正中入路Quadrant通道下椎管减压复位联合经皮椎弓根螺钉内固定术治疗合并神经损伤的单节段AO分型A3型胸腰段脊柱骨折[J].脊柱外科杂志,2021,19(5):289-295. |
后正中入路Quadrant通道下椎管减压复位联合经皮椎弓根螺钉内固定术治疗合并神经损伤的单节段AO分型A3型胸腰段脊柱骨折  点此下载全文 (Fulltext) |
| 宋鑫 张锋 韩帅 任东林 王健* |
| 上海市浦东新区人民医院骨科, 上海 201299 |
| 基金项目：浦东新区卫生系统优秀青年医学人才培养计划项目（PWRq2020-18）浦东新区卫生健康委员会学科建设计划项目（PWZy2020-04） |
| DOI：10.3969/j.issn.1672-2957.2021.05.001 |
| 摘要点击次数: 471 |
| 全文下载次数: 124 |
| 摘要： |
| 目的 比较后正中入路Quadrant通道下椎管减压复位联合经皮椎弓根螺钉内固定术和Wiltse入路椎弓根螺钉内固定联合椎板切除减压术治疗合并神经损伤的单节段AO分型A3型胸腰段脊柱骨折的临床疗效。方法 2017年1月-2020年1月，本院收治单节段AO分型A3型胸腰段脊柱骨折患者67例，其中采用后正中入路Quadrant通道下椎管减压复位联合经皮椎弓根螺钉内固定术治疗32例（Quadrant组），采用Wiltse入路椎弓根螺钉内固定联合椎板切除减压术治疗35例（Wiltse组）。记录2组患者手术时间、术中出血量、术后住院时间及手术相关并发症情况。术前、术后1 d、术后7 d检验血清肌酸激酶（CK）水平。术前、术后3个月及术后12个月测量2组患者伤椎前缘高度比、伤椎后缘高度比、局部后凸Cobb角及椎管内骨折块占位比。术前、术后3个月及术后12个月采用疼痛视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评价疼痛程度及功能状态；术前及术后12个月采用美国脊髓损伤协会（ASIA）分级评估神经功能，采用Goutallier分级评估椎旁肌脂肪浸润程度。结果 所有手术顺利完成，所有患者随访（18.60±6.13）个月。Quadrant组手术时间较Wiltse组长，术后住院时间较Wiltse组短，差异均有统计学意义（P<0.05）。术后1 d，Quadrant组血清CK水平低于Wiltse组，差异有统计学意义（P<0.05）；术后7 d组间差异无统计学意义（P>0.05）。术后2组伤椎前缘高度比、伤椎后缘高度比、局部后凸Cobb角、椎管内骨折块占位比、VAS评分及ODI均较术前显著改善，且Quadrant组改善优于Wiltse组，差异均有统计学意义（P<0.05）。术后12个月，2组神经功能ASIA分级和椎旁肌脂肪浸润程度Goutallier分级均较术前显著改善，差异有统计学意义（P<0.05）；组间差异无统计学意义（P>0.05）。结论 后正中入路Quadrant通道下椎管减压复位联合经皮椎弓根螺钉内固定术治疗合并神经损伤的单节段AO分型A3型胸腰段脊柱骨折的效果与Wiltse入路椎弓根螺钉内固定联合椎板切除减压术相当，且手术创伤更小、术后恢复更快，骨折椎体高度及椎管内有效容积恢复更好。 |
| 关键词：胸椎 腰椎 脊柱骨折 内固定器 脊柱融合术 减压术,外科 |
| Spinal canal decompression and reduction under Quadrant channel via posterior midline approach combined with percutaneous pedicle screw fixation for treatment of single-segment AO-A3 thoracolumbar fracture with nerve injury Fulltext |
| Song Xin Zhang Feng Han Shuai Ren Donglin Wang Jian* |
| Department of Orthopaedics, People's Hospital of Shanghai Pudong New Area, Shanghai 201299, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical efficacy of Quadrant canal decompression and reduction via posterior midline approach combined with percutaneous pedicle screw fixation and Wiltse approach pedicle screw fixation combined with laminectomy and decompression in the treatment of single-segment AO-A3 thoracolumbar fractures with nerve injury. Methods From January 2017 to January 2020,67 patients with single-segment AO-A3 thoracolumbar fractures were treated in our hospital,including 32 cases treated with Quadrant canal decompression and reduction via posterior midline approach combined with percutaneous pedicle screw fixation(Quadrant group),and 35 with Wiltse approach pedicle screw fixation combined with laminectomy and decompression(Wiltse group). The operation time,intraoperative blood loss,postoperative hospital stay and operation related complications of the 2 groups were recorded. Serum creatine kinase(CK) level were detected at pre-operation,postoperative 1 d and postoperative 7 d. The anterior edge height ratio of injured vertebra,posterior edge height ratio of injured vertebra,local kyphosis Cobb's angle and the occupancy ratio of intraspinal fracture fragment were measured at pre-operation,postoperative 3 months and postoperative 12 months. Visual analogue scale(VAS) score and Oswestry disability index(ODI) were used to evaluate the pain intensity and functional status at pre-operation and postoperative 12 months. The neurological function was evaluated by American Spinal Injury Association(ASIA) classification,and the degree of fat infiltration in paravertebral muscle was evaluated by Goutallier classification at pre-operation and postoperative 12 months. Results All the patients were followed up for (18.60±6.13)months. The operation time of Quadrant group was longer than that of Wiltse group,and the postoperative hospital stay was shorter than that of Wiltse group,and the differences were statistically significant(P<0.05). The serum CK level at postoperative 1 d in Quadrant group was lower than that in Wiltse group,with a statistical significance(P<0.05);there was no significant difference between the 2 groups at postoperative 7 d(P>0.05). The anterior edge height ratio of injured vertebra,posterior edge height ratio of injured vertebra,local kyphosis Cobb's angle,the occupancy ratio of intraspinal fracture fragment,VAS score and ODI of the 2 groups at post-operation were significantly improved compared with those at pre-operation,and Quadrant group was better than Wiltse group,the differences were statistically significant(P<0.05). At postoperative 12 months,ASIA classification of neurological function and Goutallier classification of paravertebral muscle fat infiltration of the 2 groups were significantly improved compared with those at pre-operation,all with a statistical significance(P<0.05);but there was no statistical significance between the 2 groups(P>0.05). Conclusion The effect of Quadrant canal decompression and reduction via posterior midline approach combined with percutaneous pedicle screw fixation in the treatment of single-segment AO-A3 thoracolumbar fractures with nerve injury is similar to Wiltse approach pedicle screw fixation combined with laminectomy and decompression,with smaller surgical trauma,faster postoperative recovery,and better recovery of vertebral height and effective volume in spinal canal. |
| Keywords:Thoracic vertebrae Lumbar vertebrae Spinal fractures Internal fixators Spinal fusion Decompression,surgical |
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