前路手术治疗胸腰椎骨折伴脊髓损伤

目的探讨前路减压内固定术对胸腰椎骨折伴脊髓损伤的应用价值。方法胸腰椎骨折伴脊髓损伤患者56例，均行经前路减压内固定术。其中单节段受累50例：T10 1例、T11 2例、T12 17例、L1 19例、L2 9例、L3 2例；双节段受累6例：T12和L1 5例、T11和T12 1例。Frankel分级：A级11例，B级23例，C级15例，D级5例，E级2例。结果所有病例脊髓均获有效减压，平均随访18个月，植骨融合良好，无脊柱后凸畸形及内固定断裂或松动等并发症。伤椎高度由术前（1．5±0．2）cm恢复到（2．9±0．3）cm，后凸Cobb角由术前25°±3°恢复到5°±2°。Frankel分级：A级3例，B级8例，C级20例，D级16例，E级9例。结论前路减压内固定术是集直视下直接减压、复位、内固定、植骨融合、畸形矫正、重建脊柱稳定一次性完成的有效方法。

Anterior Decompression and Internal Fixation for Thoracolumbar Spinal Fracture Complicated with Spinal Cord Injury

Objective To investigate the clinical values of anterior decompression and internal fixation in treatment of thoracolumbar spinal fracture with spinal cord injury. Methods 56 thoracolumbar spinal fracture cases treated by anterior decompression and internal fixation were analyzed retrospectively, including 50 cases of single vertebral segment involvement （ 1 of T10, 2 of T11 , 17 of T12, 19 of L1 , 9 of L2 , and 2 of L3 ） and 6 cases of double vertebral segments involvement （5 of T12 and L1 , 1 of Tn and T12）. There were 11 cases of grade A, 23 of grade B, 15 of grade C, 5 of grade D, and 2 of grade E according to Frankel classification. Results All spinal cords were decompressed effectively. During the average of 18 months follow-up, the result showed the grafted bone was obtained good fusion, and no complication such as secondary kyphosis and internal fixator breakage or looseness was found. The height of fracture vertebrae was recovered from 1.5 ± 0.2 cm preoperatively to 2.9 ± 0.3 cm postoperatively, and the Cobb＇s kyphosis angle was recovered from 25° ± 3° preoperatively to 5° ± 2° postoperatively. The postoperative Frankel classification revealed 3 of grade A,8 of grade B,20 of grade C, 16 of grade D, and 9 of grade E. Conclusions Anterior decompression and internal fixation can accomplish multiple management under direct vision at one stage, such as decompression, reduction, internal fixation, bone grafting, abnormality correction, and spinal stability reconstruction, therefore it is an effective approach for thoracolumbar spinal fracture with spinal cords injury.