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  • Title: [MINIMALLY INVASIVE PASSAGE IN POSTERIOR LAMINOTOMY DECOMPRESSION AND INTERVERTEBRAL BONE GRAFTING COMBINED WITH PERCUTANEOUS PEDICLE SCREW FIXATION FOR TREATMENT OF Denis TYPE B THORACOLUMBAR BURST FRACTURES].
    Author: Chen L, Qin J, Wu F, Liao W, Ao J.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2016 Aug 08; 30(8):985-991. PubMed ID: 29786230.
    Abstract:
    OBJECTIVE: To evaluate the feasibility and the effectiveness of minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation for the treatment of Denis type B thoracolumbar burst fractures. METHODS: Between January 2013 and March 2015, 53 patients with Denis type B thoracolumbar burst fractures were treated by minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation. There were 37 males and 16 females with a mean age of 43 years (range, 16-57 years). The causes included falling injury from height in 23 cases, traffic accident injury in 15 cases, heavy pound injury in 7 cases, and falling injury in 8 cases. The time between injury and operation was 7 hours to 12 days (mean, 6.7 days). The involved segments included T11 in 2 cases, T12 in 7 cases, L1 in 20 cases, L2 in 18 cases, and L3 in 6 cases; based on the neurological classification of spinal cord injury by American Spinal Injury Association (ASIA), 3 cases were rated as grade A, 5 cases as grade B, 12 cases as grade C, 24 cases as grade D, and 9 cases as grade E. The operation time, bleeding volume, and postoperative drainage were recorded; postoperative visual analogue scale (VAS) was used for pain evaluation, and ASIA for neurological function assessment; CT and X-ray films were taken to observe fracture healing, bone fusion, and grafted bone absorption; The vertebral canal patency rate was calculated; the relative height of fractured vertebrae and Cobb angle were measured. RESULTS: The operation was successfully completed in all patients; the average operation time was 150 minutes (range, 90-240 minutes); the average bleeding volume was 350 mL (range, 50-500 mL); the average postoperative drainage was 80 mL (range, 20-150 mL); and the average VAS score was 2.3 (range, 1.5-4.7) at 3 days after operation. The incisions healed primarily. All the patients were followed up 12-19 months (mean, 15 months). All fractures healed at 3-9 months (mean, 6 months). No complications of broken nails, broken rod, and screw loosening occurred. At last follow-up, the vertebral canal patency rate was significantly improved when compared with preoperative value (t=27.395, P=0.000). The Cobb angle, and the anterior and posterior heights of of traumatic vertebra were significantly improved at 1 week, 1 year, and last follow-up when compared with preoperative ones (P<0.05), but there was no significant difference between different time points after operation (P>0.05). The neurological function was improved in different degrees; 1 case was rated as grade A, 4 cases as grade B, 7 cases as grade C, 15 cases as grade D, and 26 cases as grade E, showing significant difference when compared with preoperative one (Z=-5.477, P=0.000). CONCLUSIONS: Minimally invasive passage in posterior laminotomy decompression, bone graft in the injured vertebrae combined with percutaneous pedicle screw fixation is an effective method to treat Denis type B thoracolumbar burst fractures, which not only can fully decompression, but also can effectively maintain the postoperative injured vertebral height, reduce the postoperative failure risk of internal fixation and decrease operation trauma. 目的: 探讨微创通道下经椎板间隙开窗减压、椎体内植骨结合经皮椎弓根螺钉内固定术治疗DenisB型胸腰椎爆裂骨折的可行性及临床疗效。. 方法: 2013年1月-2015年3月，收治53例Denis B型胸腰椎爆裂骨折患者，采用微创通道下经椎板间隙开窗减压、椎体内植骨结合经皮椎弓根螺钉内固定术治疗。男37例，女16例；年龄16～57岁，平均43岁。致伤原因：高处坠落伤23例，交通事故伤15例，重物砸伤7例，摔伤8例。受伤至手术时间7 h～12 d，平均6.7 d。骨折节段：T11 2例，T12 7例，L1 20例，L2 18例，L3 6例。神经功能按美国脊柱损伤委员会（ASIA）分级标准：A级3例，B级5例，C级12例，D级24例，E级9例。记录手术时间、术中出血量、术后引流量，采用疼痛视觉模拟评分（VAS）评价术后切口疼痛程度；根据ASIA分级标准评估神经功能恢复情况。复查正侧位X线片及CT，观察骨折愈合以及植骨融合、吸收情况；计算椎管通畅率，评价椎管减压情况；测量伤椎前、后缘相对高度及Cobb角，评估后凸矫正丢失情况。. 结果: 手术时间90～240 min，平均150 min；术中出血量为50～500 mL，平均350 mL；术后引流量为20～150 mL，平均80 mL。术后3 d切口VAS评分为1.5～4.7分，平均2.3分。术后切口均Ⅰ期愈合。53例均获随访，随访时间12～19个月，平均15个月。影像学复查示，骨折愈合时间3～9个月，平均6个月；31例出现植骨吸收现象；无断钉、断棒及螺钉松动等并发症发生。末次随访时，伤椎椎管通畅率较术前明显改善（t=27.395，P=0.000）。术后1周、1年和末次随访时，Cobb角及伤椎前、后缘相对高度均较术前明显改善（P＜0.05）；术后各时间点间比较，差异无统计学意义（P＞0.05）。末次随访时，患者神经功能ASIA分级为A级1例、B级4例、C级7例、D级15例、E级26例，与术前比较差异有统计学意义（Z=-5.477，P=0.000）。. 结论: 微创通道下经椎板间隙开窗减压、椎体内植骨结合经皮椎弓根螺钉内固术，在椎管充分减压的同时，行伤椎终板撬拔复位、椎体内充分植骨，能有效维持术后伤椎椎体高度，降低术后内固定失败风险，减少手术创伤，是治疗Denis B型胸腰椎爆裂骨折的一种安全、有效微创术式。.
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