胸腰段爆裂骨折伴脱位的手术治疗及疗效分析

目的 探讨后路手术治疗胸腰段脊柱爆裂骨折伴脱位的疗效. 方法 选择2005年10月-2008年3月收治的胸腰段爆裂骨折合并骨折脱位患者22例,其中男17例,女5例;年龄18～56岁.受伤节段为T12～L2,骨折椎体压缩1/4～3/4,上位椎体向前脱位程度为25%～50%.手术均在伤后2周内完成.将患者按数字随机法分为两组:组Ⅰ:采用2椎体4椎弓根钉置入复位固定,组Ⅱ:采用3椎体6椎弓根钉置入复位固定.观察并比较两组手术时间、失血量、后凸角、神经功能以及腰痛评分(low back outcome score,LBOS). 结果 术后随访12～36个月,组Ⅱ手术时间长于组Ⅰ,但并没有明显增加术中失血量.在矫正率、矫正丢失及内固定失败方面,组Ⅱ均明显优于组Ⅰ.两组术后神经功能以及LBOS评分差异无统计学意义. 结论应用3椎体6枚椎弓根螺钉置入复位固定治疗胸腰段爆裂骨折伴脱位是一种安全有效的方法 .

Analysis on surgical treatment of thoracolumbar burst fractures combined with dislocation

Objective To investigate the effect of posterior operation for thoracolumbar burst fractures combined with dislocation. Methods The study involved 22 patients with thoracolumbar burst fractures combined with dislocation admitted into our hospital from October 2005 to March 2008. There were 17 males and 5 females at age range of 18-56 years. The fractures were located at T12-L2. The fractured vertebrae lost its height by 1/4 to 3/4 of the normal height. The upper vertebral dislocation ex-tent was from 25% to 50%. All operations were accomplished within two weeks after injury. The patients were randomly divided into two groups, ie, Group Ⅰ (implanted with 4 pedicle screws in upper and lower vertebrae adjacent to the fractured vertebrae) and Group Ⅱ (implanted with 6 pedicle screws in 2 upper and 1 lower vertebrae adjacent to the fractured vertebrae). The operation time, volume of blood loss, ky-photic angle, neurological function and Low Back Outcome Score (LBOS) were compared between two groups. Results All patients were followed up for 12-36 months. The duration of operation in Group Ⅱ was longer than Group Ⅰ (P < 0.05), with no increase of intraoperative blood loss. Group ⅡI was su-perior to Group Ⅰ in aspects of correction rate, correction loss and implant failure rate (P < 0.05). There was no statistical difference in aspects of neurological function recovery and low back outcome score be-tween two groups. Conclusion Fixation with three vertebrae and six pedicle screws through posterior approach is an effective, feasible and safe procedure for treatment of thoracolumbar burst fractures com-bined with dislocation.