伴神经功能损伤胸腰椎骨折微创通道减压经皮椎弓根钉固定△

Minimally invasive decompression and percutaneous pedicle screw fixation for thoracolumbar fractures with neurologicaldeficits

摘要:

[目的] 探讨微创扩张通道减压联合纯A-P 椎弓根内固定治疗A3 型胸腰椎骨折伴神经功能损伤的临床疗效。[方法] 回顾性分析2022 年8 月—2023 年8 月本院收治的16 例胸腰椎骨折合并神经损伤且采用上述术式治疗患者的临床资料，评估临床及影像结果。[结果] 所有患者均顺利完成手术，无严重并发症。随访时间平均（9.4±3.9） 个月，与术前相比，术后3 个月及末次随访时VAS 评分[(7.4±0.6), (1.8±0.6), (0.7±0.7), P＜0.001]、ODI 评分[(81.8±8.7), (16.5±4.6), (9.4±4.1), P＜0.001]、JOA评分[(6.6±1.5), (22.5±1.5), (26.8±1.3), P＜0.001] 及ASIA 评级[例, A/B/C/D/E, (0/0/0/16/0), (0/0/0/0/16), (0/0/0/0/16), P＜0.001] 显著改善。影像方面，与术前相比，术后3 个月及末次随访时骨折椎体前缘高度比[(61.4±12.9)%, (94.3±3.6)%, (92.1±4.0)%, P＜0.001]、节段后凸角[(9.2±5.4)°, (0.9±1.5)°, (1.0±1.5)°, P＜0.001] 均显著改善。[结论] 微创扩张通道减压联合纯A-P 经皮椎弓根螺钉固定治疗胸腰椎A3 型骨折伴轻微神经损伤可显著矫正畸形，改善神经功能。

Abstract:

[Objective] To evaluated the surgical efficacy of minimally invasive expansive decompression combined with anteroposteri-or pedicle screw fixation for type A3 thoracolumbar fractures with neurological deficits. [Methods] A retrospective analysis was conductedon 16 patients who received abovementioned surgical treatment for thoracolumbar fractures with nerve injuries between August 2022 andAugust 2023. The clinical and imaging documents were evaluated. [Results] All patients underwent the surgery successfully without any se-vere complications, and followed up for (9.4±3.9) months in mean. Compared to those preoperatively, the VAS score [(7.4±0.6), (1.8±0.6),(0.7±0.7), P＜0.001] and ODI score [(81.8±8.7), (16.5±4.6), (9.4±4.1), P＜0.001] significantly decreased, while JOA scores significantly in-creased [(6.6±1.5), (22.5±1.5), (26.8±1.3), P＜0.001] 3 months postoperatively and at the final follow-up. In term of neurological function, 9patients recovered to ASIA grade E 1 week postoperatively, additionally, all the 16 patients returned to ASIA grade E at the latest followup.Regarding to imaging, the anterior vertebral height ratio (AVHR) increased significantly [(61.4±12.9)%, (94.3±3.6)%, (92.1±4.0)%, P＜0.001], while local kyphotic angle (LKA) decreased significantly [(9.2±5.4)°, (0.9±1.5)°, (1.0±1.5)°, P＜0.001] with time preoperatively, 3months postoperatively and latest follow-up. [Conclusion] The minimally invasive expansive decompression combined with pure anteropos-terior percutaneous pedicle screw fixation is effective in correcting deformity and improving neurological function for type A3 thoracolum-bar fractures with nerve injuries.