经伤椎置钉及显微减压技术治疗胸腰椎骨折并神经损伤的临床疗效分析

doi:10.3877/cma.j.issn.2095-9141.2021.04.003

目的

探讨经伤椎置钉及显微减压技术在治疗合并神经损伤的胸腰椎骨折的手术疗效。

方法

联勤保障部队第九〇〇医院神经外科自2017年4月至2019年2月收治的65例合并神经损伤的胸腰椎骨折患者，行伤椎短节段固定，观察术前、术后1周和6、12个月伤椎前缘高度比、矢状面Cobb角改善情况；观察疼痛视觉模拟评分（VAS）及腰椎Oswestry功能障碍指数（ODI）变化情况，评估手术疗效；随访12个月，观察美国脊髓损伤学会（ASIA）分级改善情况。

结果

65例患者术后伤椎椎体前缘高度较术前逐渐增大，Cobb角逐渐减小，差异有统计学意义（P<0.05）；术后VAS、ODI评分较术前均明显改善，差异有统计学意义（P<0.05）。所有患者随访12个月，均无断钉、短棒现象，骨折愈合良好，无新增神经功能障碍，ASIA分级较术前均有不同程度的改善。

结论

经伤椎置钉联合显微减压技术，对于提高胸腰椎骨折合并神经损伤的稳定性及神经功能恢复有一定的促进作用。

关键词: 胸腰椎骨折, 椎弓根螺钉, 显微减压, 神经外科

Objective

To investigate the effect of trans-traumatic screw placement and micro-decompression in the treatment of thoracolumbar fractures with nerve injury.

Methods

From April 2017 to February 2019, 65 cases of thoracolumbar fractures with nerve injury were treated with short segment fixation in in Neurosurgery Department of the 900^th Hospital of Joint Logistics Team. The improvement of anterior height ratio and sagittal Cobb angle were observed before the operation and 1 week, 6 months and 12 months after the operation. Visual analogue scale (VAS) and Oswestry disability index (ODI) of lumbar spine were observed to evaluate the effect of operation. Follow-up for 12 months to check the grading improvement of American Spinal Injury Association (ASIA).

Results

In 65 patients, the anterior height of the injured vertebral body gradually increased and the Cobb angle gradually decreased (P<0.05), the scores of VAS and ODI after operation were significantly improved compared with those before operation, the differences were statistically significant (P<0.05). All patients were followed up for 12 months. There were no broken nails and short rods. Fracture healing were good, and no new neurological dysfunction. The ASIA grade was improved in varying degrees compared with that before operation.

Conclusion

The technique of pedicle screw fixation combined with micro-decompression can improve the stability of thoracolumbar fracture complicated with nerve injury and promote the recovery of nerve function.

Key words: Thoracic and lumbar vertebrae fracture, Pedicle screws, Micro-decompression, Neurosurgery

图1 合并神经损伤的胸腰椎骨折患者术前术后影像学表现

表1 65例患者术前术后不同时间的伤椎高度比及Cobb角的比较（±s）

指标	伤椎前缘高度比(%)	Cobb角
术前	47.8±8.5	27.6°±6.4°
术后1周	73.5±7.2^a	13.7°±4.5°^a
术后6个月	85.6±8.4^ab	12.5°±4.8°^ab
术后12个月	91.9±5.7^abc	8.4°±2.7°^abc
F值	126.403	856.306
P值	<0.001	<0.001

表1 65例患者术前术后不同时间的伤椎高度比及Cobb角的比较（±s）

指标	伤椎前缘高度比(%)	Cobb角
术前	47.8±8.5	27.6°±6.4°
术后1周	73.5±7.2^a	13.7°±4.5°^a
术后6个月	85.6±8.4^ab	12.5°±4.8°^ab
术后12个月	91.9±5.7^abc	8.4°±2.7°^abc
F值	126.403	856.306
P值	<0.001	<0.001

表2 65例患者患者术前、术后各时间点VAS、ODI评分的比较（±s）

指标	VAS	ODI
术前	5.93±0.86	58.24±20.76
术后1周	1.85±0.63^a	40.81±5.88^a
术后6个月	0.73±0.42^ab	25.66±4.72^ab
术后12个月	0.52±0.38^abc	24.65±3.59^abc
F值	879.302	116.508
P值	<0.001	<0.001

表2 65例患者患者术前、术后各时间点VAS、ODI评分的比较（±s）

指标	VAS	ODI
术前	5.93±0.86	58.24±20.76
术后1周	1.85±0.63^a	40.81±5.88^a
术后6个月	0.73±0.42^ab	25.66±4.72^ab
术后12个月	0.52±0.38^abc	24.65±3.59^abc
F值	879.302	116.508
P值	<0.001	<0.001

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Clinical efficacy analysis of thoracolumbar fracture with nerve injury treated by trans-traumatic screw placement and micro-decompression

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Clinical efficacy analysis of thoracolumbar fracture with nerve injury treated by trans-traumatic screw placement and micro-decompression