保留椎体后壁的前路技术治疗胸腰椎爆裂骨折

Objective To evaluate the clinical result and feasibility of anterior approach with posterior vertebral wall preserved in the treatment of thoracolumbar burst fracture with or without paraplegia. Methods From 2005 to 2010, 68 patients with thoracolumbar burst fracture were treated by corpectomy, strut graft and instrumentation with preserved posterior vertebral wall. There were 49 males and 19 females at average age of 39.8 years (16-62 years). Kyphotic Cobb' s angle and spinal stenotic rate was measured preoperatively and postoperatively. The neurological status was evaluated with Frankel impairment scale. Results All patients were successfully managed with this technique, with no neurological deteriorations, cerebrospinal fluid leakage or incision infections except for the pneumothorax in three patients who were then cured through expectant treatment. Screw distraction was performed for restoration of the disc height and kyphosis in 68 patients. After the fractured fragment became loose and was removed, the dura matter was exposed in 19 patients including the eerebrospinal fluid leakage in three patients. Retrograde lumbar myelography was applied in eight patients, of whom there found the blocked spinal canal in three patients and excision of the posterior vertebral wall was performed. Lack of vertebral distraction was found in two patients and extraction of the reversed bone fracture behind the posterior longitudinal ligament was performed in one. The preservation rate of the posterior vertebral wall was 95% (65/68). Fifty-two patients were followed up for mean 2.2 years (from 3 months to 4.5 years) ,which showed no lower back kyphosis. There showed 1-3 Frankel grades of improvement in spinal cord function except for five patients at Frankel grade A. The Cobb angle was average 18.2° in 68 patients preoperatively and was corrected to 9.7°in 52 patients at last follow-up. CT scan showed that the stenotic rate was 42% preoperatively and 9% at final follow up in 68 patients,with no breakage of the screw and plate. Conclusion In the management of thoracolumbar burst fractures,anterior approach is helpful for preservation of the posterior vertebral wall.

Management of thoracolumbar burst fracture through anterior approach with preserved posterior vertebral wall