分期前后路联合手术及人工椎体重建治疗胸腰椎爆裂不稳定型骨折14例疗效观察

目的探讨一期后路减压内固定联合二期前路椎体次全切人工椎体重建治疗胸腰椎爆裂不稳定型骨折的有效性及安全性。方法对14例胸腰椎爆裂不稳定型骨折行一期后路减压内固定联合二期前路椎体次全切人工椎体重建治疗，观察术后并发症、后凸Cobb''s角和植骨融合情况，采用Frankel脊髓损伤分级标准评定脊髓神经恢复情况。结果所有患者均顺利完成手术，一期手术术中出血约900~1500（1150±83）ml，术中自体血回输；手术时间95~150（120±16）min。二期手术术中出血约300~600（430±57）ml，手术时间60~120（75±11）min。术后随访时间7~15（12.3±2.1）个月，末次随访所有患者X线或CT检查示脊柱生理弧度恢复良好，植骨均获骨性融合，内植物无松动、断裂及脱位情况，椎体高度未见明显丢失。患者术前与末次随访时后凸Cobb''s角及视觉模拟评分法评分比较差异均有统计学意义（均P＜0.05）。12例患者Frankel脊髓损伤分级均有1~2级的改善。结论波及三柱的胸腰椎爆裂不稳定型骨折，分期前后路联合手术及人工椎体重建治疗是一个不错的选择。人工椎体用于伴有后方韧带复合体损伤的脊柱骨折疗效良好。

Artificial vertebral body reconstruction surgery through staged anterior combining with posterior approach for treatment of unstable thoracolumbar vertebra burst fracture

Objective To investigate the efficacy and safety of artificial vertebral body reconstruction surgery through staged anterior combining with posterior approach for treatment of unstable thoracolumbar vertebra burst fracture. Methods Fourteen patients with thoracolumbar burst fracture underwent reconstruction surgery with posterior decompression and internal fixation, anterior vertebral subtotal resection and artificial vertebral body implantation. The postoperative complications, kyphosis Cobb''s angle and bone graft fusion were observed, and spinal cord nerve recovery was evaluated by Frankel spinal cord injury classification. Results The operations were successfully completed in all patients. In the first stage of operation the mean volume of intraoperative blood loss was 900-1 500(1 150±83)ml, intraoperative autologous blood transfusion was applied, and the operation time was 95-150(120±16)min. In the second stage of operation the mean volume of blood loss was 300-600(430± 57)ml, and the operation time was 60-120(75±11)min. Patients were followed up for 7 to 15 month with an mean of 12.3±2.1 months. The X-ray showed that bone fusion was achieved in all operated intervertebral spaces, no loss of the vertebral height and the artificial prosthesis. The Frankel classification was improved by 1-2 grade in 12 patients. Conclusion The staged anterior combining with posterior approach surgery is a good choice for the unstable thoracolumbar vertebrae burst fracture involving three columns. Artificial vertebral body has certain advantages in the treatment of spinal fractures with posterior ligamentous complex injury.