微创经皮椎弓根螺钉系统治疗胸腰椎压缩性骨折复位技术探讨

Abstract

目的：探讨微创经皮椎弓根螺钉系统治疗胸腰椎压缩性骨折理想的复位技术。方法：选择成都体育学院附属体育医院2012年7月~2013年10月通过微创经皮椎弓根螺钉系统治疗的胸腰段单节段压缩性骨折患者26例，通过观测术前、术后3天的后凸Cobb角、伤椎前缘高度百分比(FVHR)变化，对复位效果进行评价。结果：采用体位复位及万向椎弓根螺钉复位内固定1例，术前Cobb角19˚、FVHR45.7%，术后Cobb角19˚、FVHR 67.9%；采用手法及体位复位、万向椎弓根螺钉复位内固定3例，术前Cobb角平均18.7、FVHR平均52.4%，术后Cobb角平均5.7˚、FVHR平均87.7%；采用手法及体位复位、直向椎弓根螺钉复位内固定22例，术前Cobb角平均17 ± 5.6°、FVHR 51.5 ± 8.3%，术后Cobb角平均3.2 ± 2.5°、FVHR平均94.5 ± 3.6%。结论：采用术前手法复位及体位复位、结合术中直向椎弓根螺钉的器械复位，是微创经皮椎弓根螺钉系统治疗胸腰椎压缩性骨折的有效复位技术。 Objective: To investigate the reasonable fracture reduction technology of minimally invasive per-cutaneous pedicle screw system in the treatment of thoracolumbar compression. Method: From July 2012 to October 2013, 26 patients with thoracolumbar single segmental fracture were treated by percutaneous pedicle screw system, and observation were conducted to investigate the injured vertebra reduction result, along with the anterior vertebral height ratio (FVHR) and Cobb angle within 3 days, to evaluate the effect of reduction. Results: 1 case was treated by the postural re-duction and universal pedicle screw internal fixation, with preoperative FVHR at 45.7%, and 67.9% within 3 days, the preoperative Cobb angle at 28°, and 19° within 3 days; 3 case were treated by manipulation and postural reduction, universal pedicle screw internal fixation, with the average preoperative FVHR at 52.4%, and 87.7% within 3 days, the average preoperative Cobb angle at 18.7°, and 5.7° within 3 days. 22 case was treated by manipulation and postural reduction, straight pedicle screw internal fixation, with the average preoperative FVHR at 56.5 ± 4.3%, and 94.5 ± 3.6% within 3 days, the average preoperative Cobb angle at 17 ± 5.6°, and 3.2 ± 2.5° within 3 days. Con-clusion: The method of preoperative manipulative reduction and postural reduction, combined with surgery to reposition in the straight pedicle screw, is an effective reduction technique in minimally invasive percutaneous pedicle screw system in treatment of thoracolumbar compression fracture.