Sextant经皮椎弓根钉棒微创系统治疗胸腰椎骨折：随访评价

背景：胸腰椎骨折的保守与传统开放复位内固定治疗均存在诸多不足，微创经皮椎弓根钉棒系统为胸腰椎骨折治疗提供了新的方法。 目的：观察Sextant经皮椎弓根螺钉微创系统治疗胸腰椎骨折的临床效果。 方法：共纳入55例患者，均因单个椎体的单纯压缩性骨折于2011年2月至2013年1月在武汉大学人民医院骨科分别行经皮椎弓根螺钉微创固定和传统开放复位内固定。所有患者均无神经症状和体征。Sextant微创内固定组25例，开放复位内固定组30例。记录并比较2组手术时间、术中失血量、内固定后引流量、住院时间、内固定前后矢状位Cobb角和椎体前缘高度百分比。 结果与结论：除开放复位内固定组2例患者出院后失访外，其余患者均获得随访，总随访时间为8-14个月。微创内固定组患者的手术时间、术中失血量、内固定后引流量和住院天数均显著优于开放复位内固定组(P=0.000 0)；2组患者内固定后1周矢状位Cobb 角显著低于内固定前(P=0.000 0)，椎体前缘高度百分比显著高于内固定前(P=0.000 0)；2组内固定后8个月随访时的矫正丢失量差异无显著性意义。提示Sextant经皮椎弓根螺钉微创系统治疗胸腰椎(T₁₁-L₅)单节段椎体骨折矫正效果满意，但临床应用时需掌握其准确适应证。

Percutaneous pedicle screw-rod fixation using Sextant system in the treatment of thoracolumbar fractures: follow-up evaluation

BACKGROUND:The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method. OBJECTIVE:To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrolled in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre- and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups.  RESULTS AND CONCLUSION: Except two patients in open pedicle screw fixation group were lost after discharge, all other patients were followed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.