经皮微创短节段固定治疗伴后方韧带复合体损伤的胸腰段骨折

北京大学学报(医学版) ›› 2012, Vol. 44 ›› Issue (6): 851-854.

经皮微创短节段固定治疗伴后方韧带复合体损伤的胸腰段骨折

方礼明，张亚军△，张军，黄楠，左镇华，李兵，王博，林华刚

（武警北京市总队第二医院骨科，北京100037）

出版日期:2012-12-18 发布日期:2012-12-18

Minimally invasive percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures and posterior ligamentous complex injuries

FANG Liming， ZHANG Yajun△， ZHANG Jun， HUANG Nan, ZUO Zhenhua, LI Bing, WANG Bo, LIN Huagang

(Department of Orthopaedics, Second Hospital of Beijing Municipal Corps, Beijing 100037, China)

Online:2012-12-18 Published:2012-12-18

摘要/Abstract

摘要： 目的：探讨经皮微创后路短节段固定治疗伴后方韧带复合体损伤的胸腰段骨折的安全性与有效性。方法：回顾性分析2008年9月至2010年4月武警北京市总队第二医院骨科收治的35例胸腰椎骨折患者资料，男20例，女15例；年龄18~52岁，平均34.1岁；随访时间24~36个月（平均25.8个月）。评估手术时间，术中出血量，手术前后及末次随访时损伤节段的局部后凸角及椎体高度变化，记录术后并发症的出现情况，并且术后用CT检查评价螺钉置入的准确性。结果：35例患者的平均手术时间(95.8±12.3) min，术中出血量(83.0±40.7) mL，所有患者除2例出现浅表软组织感染外无其他严重并发症。术前与术后即刻伤椎高度及后凸角度比较差异有统计学意义（P＜0．001），末次随访时伤椎高度及后凸角度与术后即刻比较差异无统计学意义（P＞0．05）。术后CT检查发现有9枚螺钉（6.4%）穿出椎弓根外，但均未引起神经症状。结论：经皮微创后路短节段固定治疗伴后方韧带复合体损伤的胸腰段骨折有良好的临床疗效，可有效地维持骨折复位，减少手术损伤。

关键词: 胸椎；腰椎；外科手术, 微创性；骨折固定术, 内；韧带

Abstract: To evaluate the efficacy and safety of minimally invasive percutaneous pedicle screw for the management of neurologically intact patients with thoracolumbar burst fractures and posterior ligamentous complex injuries. Methods: In the study, 35 patients were reviewed，including 20 males and 15 females, with an average age of 34.1 years (18 to 52), and the mean followup for 25.8 months (24 to 36). Results: The duration of surgery was (95.8±12.3) minutes and intraoperative blood loss was (83.0±40.7) mL. There were no major perioperative complications, with the exception of 2 patients who developed a superficial wound infection. LKA and VBH were significantly improved immediately after surgery （P＜0．001）. No significant loss of correction was observed in all the patients（P＞0．05）. Screw misplacement was observed in 9/140 (6.4%) and no patient showed neurological deficit as a result of screw misplacement. Conclusion: The minimally invasive percutaneous pedicle screw has a good clinical outcome in the treatment of thoracolumbar burst fractures with posterior ligamentous complex injury, which could maintain the fracture reduction effectively, and minimize the iatrogenic soft tissue injury.
KEY WORDSThoracic vertebrae；Lumbar vertebrae; Surgical procedures, minimally; Fracture fixation, internal; Ligaments

Key words: Lumbar vertebrae, Surgical procedures, minimally, Fracture fixation, internal, Ligaments

方礼明, 张亚军, 张军, 黄楠, 左镇华, 李兵, 王博, 林华刚. 经皮微创短节段固定治疗伴后方韧带复合体损伤的胸腰段骨折[J]. 北京大学学报(医学版), 2012, 44(6): 851-854.

FANG Liming， ZHANG Yajun△， ZHANG Jun， HUANG Nan, ZUO Zhenhua, LI Bing, WANG Bo, LIN Huagang. Minimally invasive percutaneous pedicle screw fixation for the treatment of thoracolumbar fractures and posterior ligamentous complex injuries[J]. Journal of Peking University(Health Sciences), 2012, 44(6): 851-854.

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