后外侧融合对胸腰椎爆裂型骨折疗效的影响

目的 观察后外侧融合对预防胸腰椎爆裂型骨折短节段固定失败的作用及意义。方法 本组60例胸腰椎爆裂型骨折患者，A组30例均为我院收治患者，B组30例均为外院手术来我院复查的患者。A组行短节段内固定自体髂骨植骨、后外侧融合术；B组仅行短节段内固定，未植骨融合。平均随访16个月，在X线侧位片上测量Cobb角、伤椎后凸角及矢状面指数（SI），临床疗效评价采用下腰痛评分法（low back outcome score，LBOS）。结果 手术前、后两组间Cobb角、伤椎后凸角、SI比较，差异无统计学意义（P〉0．05），而末次随访时两组间Cobb角、伤椎后凸角、SI比较，差异有统计学意义（P〈0．01）。LBOS评分A组的优良率为73％（22／30），B组仅为43％（13／30）。结论 后外侧融合是降低内固定失败、减少纠正丢失等并发症的有效措施，只行内固定而不做植骨融合明显增高了并发症的发生率，是不恰当的手术方式。     

胸腰段爆裂骨折融合与非融合手术方式的Meta分析

目的 比较植骨融合内固定术与非融合内固定术治疗胸腰段爆裂骨折的临床治疗结果.方法 检索PubMecd、Science Direct、Medline、CNKI等数据库,获得2012年3月以前植骨融合内固定术(融合组)与非融合内固定术(非融合组)治疗胸腰段爆裂骨折的临床对照研究.对纳入的文献进行质量评价,提取资料并用RevMan 5.1对各研究结果进行合并,计量资料以均值差及双侧95％可信区间(CI)作为效应尺度进行分析,计数资料采用比值比(odds ratio,OR)及双侧95％ CI作为效应尺度进行分析,部分资料通过手动合并完成.结果 检索获得相关临床对照研究英文文献8篇,中文文献1篇,相关Meta分析2篇,剔除l篇重复性研究.Meta分析结果表明,两组在后凸角矫正、术后椎体高度矫正及矫正丢失、术后神经功能改善、并发症发病率、住院时间等方面差异均无统计学意义,非融合组后凸角矫正丢失较融合组严重,而术中失血量、手术时间明显低于融合组.结论 对于部分胸腰段爆裂骨折,非融合内固定术在解除压迫、重建脊柱稳定性及预防并发症等方面与植骨融合内固定术具有相似的疗效,但显著减少了术中失血量和手术时间,并可通过取出内固定恢复固定节段的运动功能、减少邻近节段退变,从而更有利于提高患者的生活质量.     

经伤椎椎弓根螺钉内固定治疗胸腰椎爆裂骨折

目的总结经伤椎椎弓根螺钉内固定治疗胸腰椎爆裂骨折的临床经验。方法1999—2007年收治70例胸腰椎爆裂骨折患者，其中男59例，女11例；年龄20—65岁。单一节段骨折66例，其中L1骨折28例，L2骨折13例，L3骨折10例，L4骨折4例，L5骨折2例，T11骨折2例，T12骨折7例；双节段骨折3例，其中T12～L1、L1-L2和L2-L3骨折各1例；三节段骨折1例，为T12～L2。神经功能按Frankel分级：A级6例，B级26例，C级14例，D级7例，E级17例。术前椎体前缘高平均32％，后凸角平均25°，术前、术后均行X线检查。内固定方式：钛板系统（DRFS）65例，钛棒系统5例（PRSS1例，USS1例，CD3例）。结果术后随访0．5～5年，平均2．3年，术后椎体前缘高度术后恢复至95％，后凸角矫正至前凸5°。术后神经功能恢复情况：A级6例，B级18例，C级19例，D级5例，E级22例。结论经伤椎椎弓根植骨螺钉内固定可以恢复脊柱生理弯曲及伤椎前缘高度，使骨折块复位，为神经功能恢复创造条件，是治疗胸腰椎爆裂骨折的一种较好方法。DRFS钢板操作简单、固定效果确切，适合伤椎内固定物的选择。     

保留椎体后壁的前路技术治疗胸腰椎爆裂骨折

目的 探讨保留椎体后壁的前路技术治疗胸腰椎爆裂骨折的临床疗效.方法2005年5月-2010年5月,采用保留椎体后壁的前路技术治疗胸腰椎爆裂骨折68例.测量术前、术后及随访时胸胺椎骨折节段的Cobb角、椎管狭窄率,采用Frankel分级法评价脊髓功能恢复状况.结果所有患者均顺利完成手术,无瘫痪症状加重、脑脊液漏及切口感染,气胸3例经对症处理治愈.骨折椎体开槽后行螺钉撑开椎问高度及后凸畸形恢复68例;因骨块粉碎严重,骨碎块松脱行骨块取出致硬膜囊部分裸露19例.其中3例出现脑脊液漏用安可胶封堵;术中C形臂X线机透视怀疑骨折块复位不全采用腰椎管逆行造影8例,有3例因椎管造影仍有梗阻改为椎体后壁切除,其中骨折椎体撑开不足2例,后纵韧带后方骨块翻转取出1例.椎体后壁保留95%(65/68).52例患者获得3个月～4.5年(平均2.2年)随访,无腰背部后凸畸形,腰背部酸胀疼痛5例.脊髓功能(Frankel分级)除5例A级无恢复外,均有1～3级的改善.术前68例胸腰椎Cobb 角平均18.2°,末次随访时52例Cobb角平均9.7°;术前椎管狭窄率平均42%,末次随访时CT扫描17例椎管狭窄率9%.未见钉板或钉棒系统断裂,钢板螺钉松动下沉4例.结论胸腰椎爆裂骨折采用前路技术治疗大部分患者可保留椎体后壁.

Abstract：

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.     

胸腰椎爆裂骨折去除内固定后后凸畸形发生原因分析

目的 回顾分析胸腰椎爆裂骨折去除内固定后是否继发后凸畸形.方法 18例胸腰椎爆裂骨折(T11～L2)采用短节段椎弓根钉固定术,术后1年取出内固定物,测量内固定取出术后0.5～2年Cobb角度变化及伤椎椎体高度的变化.结果 18例患者(35～68岁)术后随访6～24个月(平均18.7个月),无术中、术后并发症发生,无椎弓根钉断裂或松动现象.与取内固定钉前相比,16例无骨质疏松患者取钉后6个月Cobb角平均丢失0.7°,椎体高度丢失0.8 mm;取钉后1年Cobb角平均丢失1.9°,椎体高度丢失1.1 mm(P＞0.05);取钉后2年Cobb角平均丢失2.4°,椎体高度丢失1.3mm(P＞0.05).合并骨质疏松的2例患者,取钉后6个月Cobb角丢失6°、8°,椎体高度丢失3mm、5 mm;取钉后1年Cobb角丢失13°、17°,椎体高度丢失5 mm、7 mm;取钉后2年Cobb角丢失15°、19°,椎体高度丢失6 mm、7.5 mm.结论 胸腰椎爆裂骨折内固定术后脊柱后凸畸形会有轻度发展,但椎体高度丢失并不明显.若合并骨质疏松,胸腰椎爆裂骨折内固定术后脊柱后凸畸形会明显发展.

Abstract：

Objective To retrospectively analyze whether the kyphosis exists after removal of the internal fixators for thoracolumabar vertebrae fractures. Methods A total of 18 patients (35-68 years old) with thoracolumabar vertebrae fractures (T11-L2 ) were fixed with short segment pedical screw. The fixators were removed one year postoperatively to observe the changes of the Cobb' s angle and trauma vertebra'height. Results All the patients were followed up for 6-24 months ( average 18.7 months),which showed no intraoperative or postoperative complication, breakage or loosening of the screws. Compared to the Cobb angle and the vertebra height before removal of the internal fixators, the average loss of the Cobb angle was 0.7° and that of the vertebra height was 0.8 mm six months after removal of the fixators, 1.9° and 1.1 mm respectively one year after removal of the fixators, and 2.4° and 1.3 mm respectively two years after removal of the fixators in 16 patients without osteoporosis (P ＞0. 05). Among two patients with osteoporosis, the average loss of the Cobb angle and the vertebra height was 6° and 8°respectively and 3 mm and 5 mm respectively six months after removal of the fixators; 13° and 17° respectively and 5 mm and 7 mm respectively one year after removal of the fixators; 15° and 19° respectively and 6 mm and 7.5 mm two years after removal of the fixators. Conclusions After the internal fixation for thoracolumbar vertebrae burst fractures, kyphosis develops mildly, with insignificant change of the vertebral height. While the kyphosis becomes worse after removal of the fixators for thoracolumbar vertebrae burst fractures in patients with osteoporosis.     

手术治疗胸腰椎严重爆裂骨折（附36例临床分析）

报告手术治疗胸腰椎严重爆裂骨折３６例，碎骨块占椎管容积３０％以上。完全性截瘫１９例，不完全截瘫１７例。全组均经惟管减压、后路器械固定（Ｌｕｑｕｅ方法２９例，Ｇａｌｖｅｓｔｏｎ方法４例，Ｓｔｅｆｆｅｅ方法２例，Ｄｉｃｋ方法１例）。结果：３６例中３４例椎管减压充分，２例经ＣＴ复查证实碎骨块残留。３６例内固定术后近期脊柱均重获稳定，远期失稳３例。术后神经功能恢复好转率６９．４％。认为，ＣＴ扫描能清楚显示     

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.     

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 .     

前路有限减压单节段植骨内固定治疗Denis B型胸腰椎爆裂骨折

目的 探讨前路有限减压相邻椎体单节段植骨内固定治疗Denis B型胸腰椎爆裂骨折的可行性及临床疗效.方法 回顾性分析10例应用前路有限减压相邻椎体单节段植骨内固定术治疗Denis B型胸腰椎爆裂骨折的患者,观察复位、植骨融合、神经功能恢复、矫正丢失、腰痛、腰椎活动情况及融合椎体相邻椎间盘退变等并发症发生情况.结果 所有患者术后均获得6～29 个月(平均14个月)的随访.术后随访3～5 个月时达骨性融合,所有患者均获得满意复位,复位率达95%.重建的椎体高度无丢失,神经功能恢复1～2级.术后腰痛症状明显缓解,未出现顽固性腰痛、腰椎活动受限等并发症.融合节段相邻椎问盘未见明显退变,临床效果优于多节段内固定. 结论只要适应证选择合适,前路有限减压相邻椎体单节段植骨内固定可达到满意复位、坚强骨性融合、良好的神经功能恢复,且较三椎体二节段固定可减少固定节段、降低腰椎活动受限及相邻椎间盘退变等并发症的发生.     

胸腰段脊柱爆裂骨折前路与后路手术疗效对比观察

目的 对胸腰椎爆裂骨折行前路手术和后路手术的患者进行回顾性研究,客观评价不同手术入路治疗后的影像学结果,为胸腰椎爆裂骨折的外科治疗提供可靠的参考.方法 筛选2003年1月-2005年12月收治的41例胸腰椎爆裂骨折患者作为研究对象,随访24～48个月,平均38个月.按照手术人路分为前路手术和后路手术两组.根据随访X线侧位片测量Cobb角作为效果评价标准,并进行统计学分析.结果 前路手术组共19例,人院时平均Cobb角为27.3°,术后为3.1°,随访结束时为4.6°;后路手术组共22例,入院时平均Cobb角为26.1°,术后为3.0°,随访结束时为12.5°.两组患者术前和术后即刻Cobb角差异无统计学意义(P>0.05),但随访结束时两者差异有统计学意义(P<0.01).结论 前路手术对于改善和维持胸腰椎爆裂骨折后凸角度优于后路手术.     

胸腰椎骨折伴截瘫后路椎弓根内固定术后的前路翻修术

目的探讨胸腰椎骨折伴截瘫后路椎弓根内固定失效后,前路翻修术的理论依据和手术适应证。方法1999年2月-2005年4月,收治胸腰椎骨折伴截瘫行后路短节段椎弓根钉棒系统固定术后失败的患者21例。根据患者临床表现和影像检查结果,采用后路钉棒系统取出Ⅰ期胸腰椎前路手术行脊髓减压、椎间植骨融合内固定。术后随访患者脊髓功能恢复、后凸畸形矫正情况。结果所有患者均顺利完成手术,术后出现肋间神经损伤2例,脑脊液漏3例,难治性股痛2例。本组患者随访3个月~6年,平均2.4年,未发生钉板系统松动断裂和后凸畸形加重20例,有1例术后4个月远位螺钉断裂。后凸畸形Cobb角由术前的(16.4±1.3)°恢复到随访时(5.2±0.3)°。21例患者中有16例神经功能得到部分恢复。结论胸腰椎骨折伴截瘫后路手术失效后,采用前路翻修术,脊髓减压直接彻底,后凸畸形矫正满意、固定牢靠,大多数此类患者均能采用此种术式。     

伤椎固定结合硫酸钙椎体成形与单纯伤椎固定治疗胸腰椎爆裂骨折的对比研究

目的 对比伤椎固定结合硫酸钙椎体成形术与单纯伤椎固定治疗胸腰椎爆裂骨折的临床疗效. 方法 2005年1月- 2008年10月对61例胸腰椎爆裂骨折患者分别采用伤椎固定结合硫酸钙椎体成形(A组)与单纯伤椎固定(B组)进行治疗.A组32例,其中男22例,女10例;年龄21～ 65岁,平均36.8岁.术后随访13 ～27个月...     

单节段复位固定治疗创伤性胸腰椎骨折

目的 评价单节段椎弓根螺钉复位固定胸腰椎爆裂性骨折的临床疗效. 方法 自2003年10月至2008年2月,采用单节段椎弓根螺钉固定治疗A3.1型(37例)、A3.2型(30例)胸腰椎骨折.术后摄X线片来测量骨折椎楔变指数、骨折节段矢状位指数评价影像学效果,并通过腰功能评分评价临床疗效. 结果 所有患者手术顺利,手术用时平均93 min,术中出血量平均157 ml.随访65例,平均随访时间为19.8个月(4～27个月),全部骨性融合,除1例出现螺钉松动外,无内固定失败.术前骨折节段平均矢状位指数及骨折椎楔变指数分别为13.06°、42.96%,术后分别为4.47°、21.78%,均较术前明显改善(P<0.01).除2例外,最后随访末见明显矫正丢失(P<0.05).临床腰功能评分较术前明显改善(P<0.05). 结论 经骨折椎单节段复位固定融合术具有创伤小、用时短、出血少、脊椎运动功能单位丢失减少等优点,可用于治疗部分胸腰椎爆裂型骨折.     

经皮椎弓根螺钉固定治疗无神经损伤胸腰椎骨折

目的 评价经皮椎弓根螺钉固定治疗无神经损伤胸腰椎骨折的安全性及有效性.方法选择2007年1月-2007年12月无神经损伤胸腰椎创伤性骨折患者15例,均于伤后10 d内手术,其中男10例,女5例;年龄31～65岁,平均45.6岁.骨折部位:T<,11>骨折1例,T<,12>骨折4例,L1骨折7例,L2骨折2例,L3骨折1例.术前进行脊柱正、侧位摄片、CT和MRI检查,评价椎体、椎管、椎间盘及韧带损伤情况.根据脊柱骨折Magerl分型:A3型骨折10例,A2型骨折3例,A1型骨折2例,进行经皮椎弓根螺钉固定治疗.记录手术时间和术中失血量,随访观察治疗效果,进行回顾性分析.结果 手术时间65～110 min,平均82 min.术中失血20～50 ml,平均35 ml.无转为开放手术患者,无神经损伤或其他并发症.随访3～11个月,平均7.6个月.Cobb角由术前(15.7±6.3).减少为术后(3.5±1.2)..CT检查显示与术前比较椎体后缘骨块复位良好.结论经皮椎弓根螺钉固定是治疗无神经损伤胸腰椎骨折安全有效的手术方法,与开放手术比较具有组织损伤轻、出血少和恢复快等优点.