后路手术治疗胸腰椎骨折132例

目的　总结分析 132例胸腰椎骨折病例的手术时机及后路椎管减压方式、椎体内植骨的疗效。方法　采用后路椎管环形减压 ,经椎弓根椎体内植骨技术 ,治疗 132例胸腰椎骨折。分析不同手术时机的手术时间与术中出血量关系 ,以选择合理手术时机。测量伤椎椎管狭窄率 ,伤椎椎体中央高度值 ,确定椎管矢状径的恢复程度及伤椎椎体高度恢复情况 ,采用配对t检验进行统计学分析。结果　 2周左右手术的病例 ,其术中出血量与 8h以内和 1～ 7d组行t检验 ,结果P <0 .0 5 ,差异有显著意义。X片示伤椎椎体中央高度值术后与术前比较 ,差异有显著意义 (P <0 .0 5 ) ,而随访时与正常值比较 ,差异无显著性意义 (P >0 .0 5 )。CT检查显示 ,术前伤椎椎管狭窄率平均 4 4 .7% ,伤椎椎管术后 1年左右出现椎管再塑形现象 ;再塑形的伤椎椎管管径与正常值比较 ,差异无显著性意义 (P >0 .0 5 )。132例患者术后平均随访 33.5个月 ,其中 111例脊髓不完全损伤患者按美国脊髓损伤协会 (ASIA)分级标准提高 1～ 3级 ;16例脊髓完全损伤患者部分神经功能有所恢复。结论　错过急诊手术时机的脊髓完全性损伤或无明显神经体征的病例 ,手术时机宜在伤后 2周左右 ;后路椎管减压应根据损伤情况采用不同方式 ,尽量保留脊柱的稳定性 ;经椎弓根椎体内植骨

Posterior routing surgical treatment of the thoracolumbar vertebral fracture:a report of 132 cases

Objective The time, the way of decompression and the efficacy of the transpedicular bone grafting were analysed in 132 cases of thoracolumbar vertebral fracture. Methods 132 cases of thoracolumbar vertebral fracture were surgically treated with different kinds of decompression combined with transpedicular internal pyramid bone grafting and short segment internal fixation. The measurements and analyses by student test were performed to estimate the relationship between the amount of bleeding and the operative moment in order to choose the appropriate operative moment and to measure the diameter of spinal canal and the middle height of the injured vertebrae in order to determine the recovery of spinal canal and the height of vertebrae. Results There was significant difference in the amount of bleeding between the group of 2 weeks after injury and the group of less than 1 week after injury. Significant difference can be found in the middle height of the injured vertebrae between the cases of preoperation and those of postoperation. However, there was no significant difference between the diameter of the remolded spinal canal and the normal value. 111 patients with incomplete injury of cords had been raised up to 1~3 grades according to the criteria of ASIA and part of the neurological functions had been regained in 16 patients with complete injury of cords.Conclusion The patients with completely injured cord or with no neurological deficits who had missed the time of emergency should undergo the operations around 2 weeks after injury. Different way of decompression should be performed depending on the levels of lesion. The transpedicular internal pyramid bone grafting can significantly increase the density of the fractured vertebrae body.