前后路短节段固定融合治疗腰椎纵向劈裂骨折

目的：评价前后路短节段固定融合治疗腰椎纵向劈裂骨折的临床效果和安全性。方法：回顾性分析中南 大学湘雅二医院脊柱外科2005年3月至2013年5月采用的前后路短节段固定融合治疗的13例腰椎纵向劈裂骨折患者临床 资料，对所有患者的矫正情况进行随访，采用疼痛视觉模拟量表(visual analogue scale，VAS)评分、Oswestry功能障碍指 数(Oswestry disability index，ODI)对腰椎功能进行评估。结果：随访时间为24~60个月，平均42个月；手术时间185~300 min，平均248 min；术中失血量为600~1 500 mL，平均950 mL。所有患者术后均获得功能及自我形象的改善，在Cobb 角评估方面，术后2 d，12个月和末次随访测量Cobb角较手术前均有明显改善，差异均有统计学意义(P<0.05)；VAS评 分和ODI评估术后2 d，12个月和末次随访测量结果较之术前均有改善， 差异均有统计学意义(P<0.05)。术后12个月与 末次随访的评估结果相比，差异无统计学意义(P>0.05)。根据美国脊髓损伤协会(ASIA)分级标准，在末次随访时，术 前8例D级患者中6例恢复至E级，其中3例未见进一步恢复；术前2例C级中1例恢复至D级，1例恢复至E级。所有病例 骨折均获愈合，愈合时间为3~6个月，平均4.5个月；术中3例有硬膜撕裂，术中给予修补；无神经血管损伤并发症病 例。结论：短节段伤椎置钉和旋棒复位是腰椎纵向劈裂不稳定骨折较好的手术选择。

Treatment of lumbar sagittal split fracture with combined#br# anterior and posterior short segment fixation and fusion

Objective: To evaluate the effi cacy and safety of combined anterior and posterior short segment fi xation and fusion for lumbar sagitt al split fracture. Methods: From March, 2005 to May, 2013, 13 patients of lumbar sagitt al split fracture underwent short segment posterior fixation and anterior fusion. Preoperative and postoperative kyphotic Cobb’s angle, visual analogue scale (VAS) score of back pain, Oswestry disability index (ODI), as well as the incidence of complication were accessed.Results: Mean follow-up duration was 42 months (24–60 months). Average operative time was 248 min (185–300 min) and average bleeding was 950 mL (600–1 500 mL). All patients were significantly improved in function and self-image. In the Cobb angle evaluation, there was significant improvement in 2 days or 12 months after the operation (P<0.05). In terms of average VAS pain score and ODI score, the difference was significant (P<0.05) between before and after surgery; the results of 12 months and the final follow-up after operation were significantly better than those before operation (P<0.05), but there was no significant difference at the 12 months and the final follow-up (P>0.05). According to the American Spinal Injury Association (ASIA) standard, in the last follow-up, 6 patients with grade D recovered to grade E, 3 patients had no further recovery. All patients achieved bony fusion in 4.5 months (3–6) months. There were 3 cases with dural tear and it was repaired during operation. There was no neurologic deterioration and vascular injury. Conclusion: The short construct with pedicle screws in the fractured vertebrae and disc space fusion may be a better therapeutic option for the highly lumbar unstable fracture of C1.2.1.