后路间接减压内固定治疗胸腰椎爆裂骨折

目的 探讨后路间接减压内固定治疗无神经损伤症状伴椎体后上缘骨折块的胸腰椎爆裂骨折的临床疗效。方法 采用后路间接减压内固定治疗35例无神经损伤症状伴椎体后上缘骨折块的胸腰椎爆裂骨折患者。记录椎管占位率、椎体压缩率、Cobb角及并发症发生情况。结果 患者均获得随访，时间12～18个月。无感染、断钉、迟发性神经损伤等并发症发生。术后3 d及1年Cobb角、椎体压缩率、椎管占位率均较术前明显减小(P<0.05),术后1年与术后3 d Cobb角、椎体压缩率比较差异均无统计学意义(P>0.05),术后1年椎管占位率较术后3 d减小(P<0.05)。结论 对于无神经损伤症状伴椎体后上缘骨折块的胸腰椎爆裂骨折，通过后路间接减压内固定复位椎管占位骨折块并通过后期的椎管重塑，能够取得良好的临床疗效。     

胸腰段爆裂骨折经后路间接减压的影像学观察

目的本文旨在探讨后路间接减压治疗胸腰段爆裂骨折对椎管减压的效果。方法选择2005年1月-2006年12月，胸腰段爆裂骨折应用后路撑开复位间接减压治疗45例，从影像学方面分析疗效。观察指标为手术前后的伤椎前后缘高度，腰椎后凸畸形（Cobb’s角），椎管的正中矢状径的变化。并应用统计学分析。结果伤椎前缘高度由术前51％恢复到术后92％；伤椎后缘高度由术前56％恢复到术后93％；Cobb’s角由术前28．6恢复到术后5．8。椎管受压程度，删除椎管开放减压4例，余受压的椎管正中矢状径由术前58％恢复到89％。结论合理选择适应证，后路撑开复位间接减压治疗胸腰段爆裂骨折对椎管减压的疗效满意，术中C臂透视分析影像学椎体后缘骨块形态有助于提高椎管减压效果。     

后路椎弓根螺钉内固定治疗胸腰椎爆裂骨折

目的探讨应用后路椎弓根内固定治疗胸腰椎爆裂骨折的效果。方法采用后路椎弓根内固定治疗胸腰椎爆裂骨折患者53例。结果全部病例随访8～54个月,伤椎椎体前、后缘高度术前平均37.2%（12%～51%）和平均78.3%（32%～87%）,术后恢复至平均94.3%（92%～97%）和平均97.5%（92%～99%）。术前Cobb角平均23°（13°～38°）,术后平均5.1°（0°～10°）。脊髓神经损伤者术后按美国脊髓损伤协会（A-SIA）标准均恢复1级以上。结论手术治疗胸腰椎爆裂骨折可有效恢复脊柱序列及椎管容积,矫正后凸畸形,有利于脊髓神经功能恢复。     

选择性椎管减压钉杆角椎弓根内固定治疗胸腰椎爆裂骨折

目的 采用选择性椎管减压钉杆角椎弓根内固定系统治疗胸腰椎爆裂骨折３０例。方法 依据骨折类型、椎管狭窄程度、骨块状态进行选择性椎管减压：轻度椎管狭窄则行间接椎减压,若有神经损伤症状同时作椎板减压;严重椎管狭窄、后柱伤,后纵韧带损伤碎骨块游离,骨块旋转则间接椎管减压＋椎板减压＋脊髓前减压。结果 ３０例中２９例减压充分,３０例固定牢固,神经恢复好转率占７０％,结论 认为在采用椎弓根螺钉治疗胸腰椎爆裂骨折     

椎管占位无神经损伤胸腰椎爆裂性骨折的手术治疗

目的 研究不减压后路AF内固定在椎管占位无神经损伤胸腰椎爆裂性骨折患者的临床疗效.方法 采用切开不减压后路AF内固定治疗37例椎管占位无神经损伤胸腰椎爆裂性骨折,术前CT检查显示椎管占位率平均20%,后凸畸形平均30,椎体高度平均压缩50%.结果 术后椎管占位率平均15%,后凸畸形平均10,椎体高度恢复平均90%.随访6～48个月,骨折在5个月左右愈合,遗留术后腰部不适2例.结论 对于这类患者行单纯后路切开复位,接减压,临床效果明显.     

RSS内固定配合后外侧植骨治疗胸腰椎爆裂骨折48例

目的 观察RSS内固定配合后外侧植骨融合治疗胸腰椎爆裂骨折的临床疗效.方法 对48例经影像学诊断为胸腰爆裂件骨折患者(18例合并不同程度的脊髓损伤),采用RSS型内固定系统固定,其中15例患者同时行椎管减压,均行后外侧植骨融合进行治疗,评价手术效果.结果 伤椎前缘高度由41.2%恢复至93.0%;后缘高度由78.5%恢复至95.3%,水平移位完全恢复;Cobb三角由术前平均34.1°恢复到术后4.2°,伤椎椎管面积由术前43.2%恢复到术后90.2%.脊髓神经功能恢复,按Frankel分级标准均有1级以上的改善.结论 后路RSS型内固定配合后外侧植骨融合是一种治疗胸腰椎爆裂性骨折的有效方法.     

AF系统胸腰椎爆裂骨折初步观察及体会

[目的]观察AF椎弓根钉内固定系统治疗胸腰椎爆裂骨折的疗效。[方法]应用AF椎弓根钉内固定系统治疗胸腰椎爆裂骨折17例。[结果]随访8个月-3年，平均随访12个月。17例椎体前缘高度由术前平均30％恢复至平均95％，椎管内移位骨块复位率达90％，神经损伤的恢复按ASIA分级：A级中1例无变化，余16例均提高1-2级。[结论]AF椎弓根钉内固定系统能达到满意复位固定及椎管有效减压，是一种治疗胸腰椎爆裂骨折理想的方法。     

GSS型椎弓根内固定系治疗胸腰椎爆裂性骨折合并脊髓损伤

目的探讨胸腰椎爆裂骨折合并脊髓损伤的手术治疗效果及GSS型椎弓根内固定系在胸腰椎爆裂骨折中的作用。方法对34例胸腰椎爆裂性骨折病人早期行后路切开复位GSS型椎弓根内固定，其中12例行半椎管切开减压，并对手术疗效进行评估。结果34例病人术后随访9～21个月，平均17个月，总优良率76．5％。影像学显示无断钉、无内固定松动现象发生。结论胸腰椎爆裂骨折合并骨髓损伤有效的治疗方法是早期切开复位内固定，GSS型椎弓根内固定系在治疗中有关键的治疗价值。     

一期后路开窗环形减压经椎弓根植骨内固定治疗胸腰椎爆裂骨折

目的 探讨后路开窗环形减压经伤椎椎弓根植骨钉棒内固定治疗胸腰椎爆裂骨折的效果.方法 对胸腰椎爆裂骨折19例采用一期后路开窗环形减压经椎弓根植骨内固定术治疗.结果 随访12～36个月,术后Cobb角0～12°,椎体前缘高度恢复至90％～100％,平均94.2％.术后12个月时Cobb角0～15°.结论 一期后路开窗环形减压经伤椎椎弓根植骨内固定治疗胸腰椎爆裂骨折,可重建脊柱稳定性,防止矫正角度及高度的再丢失,避免继发椎管狭窄.     

经椎弓根减压与AF内固定治疗胸腰椎爆裂骨折

目的探讨一种治疗胸腰椎爆裂性骨折伴脊髓神经损伤的方法。方法回顾我院骨科自1998年2月-2002年4月所收治胸腰段椎体爆裂骨折伴脊髓神经损伤患者28例,采用后路经椎弓根减压椎管前壁成形与AF内固定同时植骨融合治疗,对其预后及随访结果进行分析。结果28例患者平均随访18个月(6个月～4年),Cobb角术前平均31°,术后矫正为10°。28例中26例术后神经功能恢复提高1～3个Frankel分级。结论本技术方法具有创伤相对较小、操作简便、减压充分、内固定牢固、方便植骨融合等优点,且矫正脊柱后凸畸形,恢复椎管容积,重建脊柱稳定性,促进脊髓神经功能恢复,是一种治疗胸腰段椎体爆裂骨折伴脊髓神经损伤有效方法之一。     

胸腰段爆裂骨折经后路间接减压的影像学观察

目的本文旨在探讨后路间接减压治疗胸腰段爆裂骨折对椎管减压的效果。方法选择2005年1月-2006年12月,胸腰段爆裂骨折应用后路撑开复位间接减压治疗45例,从影像学方面分析疗效。观察指标为手术前后的伤椎前后缘高度,腰椎后凸畸形(Cobb's角),椎管的正中矢状径的变化。并应用统计学分析。结果伤椎前缘高度由术前51%恢复到术后92%;伤椎后缘高度由术前56%恢复到术后93%;Cobb's角由术前28.6恢复到术后5.8。椎管受压程度,删除椎管开放减压4例,余受压的椎管正中矢状径由术前58%恢复到89%。结论合理选择适应证,后路撑开复位间接减压治疗胸腰段爆裂骨折对椎管减压的疗效满意,术中C臂透视分析影像学椎体后缘骨块形态有助于提高椎管减压效果。     

Modified transpedicular approach for the surgical treatment of severe thoracolumbar or lumbar burst fractures.

BACKGROUND CONTEXT: Conventional transpedicular decompression of the neural canal requires a considerable amount of lamina, facet joint and pedicle resection. The authors assumed that it would be possible to remove the retropulsed bone fragment by carving the pedicle with a high-speed drill without destroying the vertebral elements contributing to spinal stabilization. In this way, surgical treatment of unstable burst fractures can be performed less invasively. PURPOSE: The purpose of this study is to demonstrate both the possibility of neural canal decompression through a transpedicular approach without removing the posterior vertebral elements, which contribute to spinal stabilization, and the adequacy of posterior stabilization of severe vertebral deformities after burst fractures. STUDY DESIGN: Twenty-eight consecutive patients with complete or incomplete neurological deficits as a result of the thoracolumbar burst fractures were included in this study. All patients had severe spinal canal compromise (mean, 59.53%+/-14.92) and loss of vertebral body height (mean, 45.14%+/-7.19). Each patient was investigated for neural canal compromise, degree of kyphosis at fracture level and fusion after operation by computed tomography and direct roentgenograms taken preoperatively, early postoperatively and late postoperatively. The neurological condition of the patients was recorded in the early and late postoperative period according to Benzel-Larson grading systems. The outcome of the study was evaluated with regard to the adequate neural canal decompression, fusion and reoperation percents and neurological improvement. METHODS: Modified transpedicular approach includes drilling the pedicle for removal of retropulsed bone fragment under surgical microscope without damaging the anatomic continuity of posterior column. Stabilization with pedicle screw fixation and posterior fusion with otogenous bone chips were done after this decompression procedure at all 28 patients included in this study. RESULTS: Twenty-three of 28 patients showed neurological improvement. The percent of ambulatory patients was 71.4% 6 months after the operation. The major complications included pseudarthrosis in five patients (17.8%), epidural hematoma in one (3.5%) and inadequate decompression in one (3.5%). These patients were reoperated on by means of an anterior approach. Of the five pseudarthrosis cases, two were the result of infection. CONCLUSION: Although anterior vertebrectomy and fusion is generally recommended for burst fractures causing canal compromise, in these patients adequate neural canal decompression can also be achieved by a modified transpedicular approach less invasively.     

钉棒及钩棒系统治疗胸腰椎多节段脊柱骨折

目的评价钉棒及钩棒系统治疗胸腰椎多节段脊柱骨折的临床疗效。方法23例多节段胸腰椎骨折患者，后路切开复位，选择性椎管减压．钉棒或钩棒系统内固定及后外侧植骨融合进行手术治疗。其中相邻多节段型13例，非相邻多节段型8例，混合型2例。结果全组病例平均随访14个月，未发现内固定物松动、断离，无继发性脊柱后凸畸形加重。椎体高度由术前平均48．4％恢复至术后平均92．4%。2例完全性及11例不完全性脊髓损伤者．脊髓神经功能获改善。结论在椎管进行充分减压的基础上．钉棒及钩棒系统能有效复位椎体骨折，重建脊柱稳定性，是多节段胸腰椎不稳定性骨折合并脊髓神经损伤后路手术的理想选择。     

Anterolateral decompression for neural involvement in thoracolumbar fractures. A review of 78 cases

Of a total of 905 patients with fracture or fracture-dislocation of the thoracolumbar spine admitted from 1969 to 1982, a neurological deficit was present in 334 (37%). All unstable injuries were initially treated by reduction and posterior fusion. In 79 of these patients, an anterolateral decompression was undertaken later because of persistent neurological deficit and radiographic demonstration of encroachment on the spinal canal. One patient died of pulmonary embolism; 78 were reviewed after a mean period of four years. Of these 78 patients 18 made a complete neurological recovery while 53 appeared to have benefited from the procedure; 25 remained unchanged. The best results were obtained in burst fractures at thoracolumbar and lumbar levels when a solitary detached fragment of a vertebral body had been displaced into the spinal canal. These results indicate that anterolateral decompression of the spinal canal should be considered, after careful evaluation, for certain injuries of the spine in which there is severe neural involvement.     

椎板回植椎管成形治疗严重胸腰椎爆裂性骨折伴椎管狭窄

目的：探讨椎板回植椎管成形治疗严重胸腰椎爆裂性骨折伴椎管狭窄的手术技巧、疗效及适应证。方法：41例胸腰椎骨折伴椎管狭窄患者，采用椎板回植椎管成形术。观察术后伤椎椎管大小、脊柱的稳定性、椎体高度的恢复及神经功能恢复情况。结果：全部病例经1～3年的随访，伤椎椎体前缘高度由术前58％恢复至97％，椎体后缘（中柱）高度由术前76％恢复至98．7％，Cobb角由术前平均24．6。恢复至术后1．8°。伤椎椎管剩余容积由术前43％恢复至术后93％。瘫痪恢复按Frankel分级：A级中1倒无变化，余40例均提高1-3级。结论：椎板回植椎管成形治疗严重胸腰椎爆裂性骨折伴椎管狭窄是一种较理想的手术方法，此方法操作相对简单、安全，彻底解除神经及硬膜囊压迫的同时扩大了椎管，杜绝了继发性椎管狭窄，重建了后柱结构，增加了脊柱稳定性，值得推广。     

前后路手术治疗胸腰椎陈旧性骨折

目的 探讨前后路手术在陈旧性胸腰椎骨折治疗中的应用价值。方法 对56例陈旧性胸腰椎骨折经前路或后路行椎管扩大减压植骨、内固定术。结果 所有患者随访6个月～5年，平均19个月.56例术后症状明显缓解，受压脊髓得到有效减压，植骨融合率高，前路手术脊髓神经功能改善优于后路手术，并发症少。结论 椎管侧前路减压对陈旧性胸腰椎骨折的治疗有效，后路手术适用于单纯脊柱失稳者。     

爆裂性胸腰椎骨折手术治疗的选择

目的 探讨爆裂性胸腰椎骨折的手术治疗方法及其疗效. 方法 内固定治疗的爆裂性胸腰椎椎骨骨折的患者76例,骨折类型按Denis分型:A型25例,B型33例,D型10例,E型8例.ASIA损害分级:A级19例、B级8例、C级12例、D级17例、E级20例.20例采用经后路椎管减压脊柱固定者60例,采用前路椎管减压脊柱固定者16例. 结果 本组均获随访,时间5～ 48个月,平均随访(30.0±10.2)个月.术后ASIA脊柱感觉运动损害分级:A级8例、B级9例、C级10例、D级10例、E级35例.本组术前Cobb角平均为(37.2°±15.6°),术后为(7.9°±5.8°),较术前有明显好转(P＜0.01).术前椎体压缩程度56.8％±20.1％,术后为12.8％±16.4％,较术前有明显好转(P＜0.05). 结论 对于胸腰椎爆裂性骨折的手术,前后路手术各有优缺点,对于不同病情的患者应因人而异,个体化选择.     

Management of thoracolumbar fractures with accompanying neurological injury.

The optimal surgical approach for spinal canal reconstruction of thoracolumbar fractures is controversial, and the relationship between spinal canal reconstruction and neurological recovery remains unclear. To address these issues, 22 consecutive cases of thoracolumbar fracture with accompanying neurological deficit were reviewed. Neurological status was graded at the time of admission, postoperatively, and at a mean of 15 months postinjury. By using preoperative and postoperative radiographs and computed tomographic scans, the degree of spinal canal compromise was quantified in the sagittal, coronal, and axial planes. All fractures were stabilized by posterior instrumentation and fusion, and in 10 injuries, retropulsed vertebral body fragments were further reduced by posterolateral decompression. Spinal canal dimensions, neurological function, and operative approach were compared by using nonparametric statistical analysis. The greater the initial spinal canal compromise, the more severe the neurological deficit (P = 0.04). With injuries involving L1 and above, this relationship increased (P = 0.003). The extent of spinal canal reconstruction failed to correlate with neurological recovery. Compared with spinal instrumentation alone, transpedicular decompression showed no benefit in terms of postoperative canal dimensions or neurological outcome. On the basis of this experience, transpedicular decompression offers no advantage over spinal instrumentation alone. The relationship between initial spinal canal encroachment and neurological deficit demonstrates that the degrees of bony and neurological injury directly reflect the kinetic energy transferred at the time of impact. The lack of correlation between the extent of spinal canal reconstruction and neurological recovery suggests that ongoing neural compression/distortion contributes little to the overall neurological injury.