后外单侧入路椎体次全切融合钉棒固定治疗胸腰椎爆裂性骨折

目的 :探讨后外单侧入路椎体次全切融合钉棒固定与侧前方入路椎体次全切植骨融合钉板固定治疗胸腰椎爆裂性骨折的临床疗效。方法:回顾性分析2008年1月至2014年5月行手术减压、融合、内固定的36例胸腰椎爆裂性骨折患者。后路组16例,其中男13例,女3例;年龄37~62岁;坠落伤9例,车祸伤3例,重物砸伤4例;损伤节段:T122例,L15例,L27例,L32例;ASIA分级:A级3例,B级2例,C级2例,D级5例,E级4例;伤后距手术时间5~15 d。侧前方组20例,其中男15例,女5例;年龄27~62岁;坠落伤12例,车祸伤4例,重物砸伤4例;损伤节段:T122例,L17例,L29例,L32例;ASIA分级:A级4例,B级2例,C级4例,D级6例,E级4例;伤后距手术时间4~12 d。观察两组的手术时间、术中出血量和术后引流量,并对其神经功能ASIA等级变化、临床疗效、胸腰椎前凸角改善度数、骨性融合等进行比较。结果:所有患者获到随访,时间12~24个月,平均(15.8±3.3)个月。后路组和侧前方组手术时间、术中出血量和术后引流量差异均无统计学意义(P0.05)。末次随访两组ASIA分级与术前比较差异有统计学意义(P0.01),表明两组术后神经功能均获得不同程度的恢复。两组JOA评分末次随访与术前比较差异有统计学意义(P0.01),表明两组均获得较好临床疗效。两组间ASIA分级结果、JOA评分、RIS临床疗效无差异。两组均获得融合。胸腰椎前凸角改善度数两组间比较差异无统计学意义,两组相对术后较术前差异均有统计学意义,表明两种入路均能有效恢复脊柱序列。结论:对胸腰椎爆裂性骨折只需椎管前方减压和前中柱重建的病例,可根据术者对术式的熟练程度及患者的病情来选择,但对椎管前后均需减压、三柱重建而需前后联合入路的病例,后外单侧入路椎体次全切融合钉棒固定明显缩短了手术时间,减少了手术的创伤,值得临床推广。

Clinical studies of pedicle screw-rod fixation of thoracolumbar burst fractures through posterior unilateral approach after vertebrae corpectomy fusion

Objective:To compare the clinical curative effect of thoracolumbar burst fracture treated by the posterior unilateral approach corpectomy fusion screw-rod fixation and anterior corpectomy bone fusion screw plate fixation.Methods: From January 2008 to May 2014,36 cases of thoracolumbar burst fracture underwent operation of decompression,fusion,and internal fixation was retrospective analyzed. Among them,16 patients were treated through posterior approach as posterior group,including 13 males and 3 females aged from 37 to 62 years old;9 cases caused by falling injury,3 cases by traffic accident injury,4 cases by heavy aboved;the injury segment was on T₁₂ in 2 cases,L₁ in 5 cases,L₂ in 7 cases,L₃ in 2 cases; according ASIA grade,3 cases were grade A,2 cases were grade B,2 cases were grade C,5 cases were grade D,4 cases were grade E; the time between injury and operation ranged from 5 to 15 days. Other 20 patients were treated through anterior-lateral approach as anterior-lateral group,including 15 males and 5 females with age from 27 to 62 years old; 12 cases caused by falling injury,4 cases by traffic accident injury,4 cases by heavy aboved; the injury segment was on T₁₂ in 2 cases,L₁ in 7 cases,L₂ in 9 cases,L₃ in 2 cases;for ASIA grade: 4 cases were grade A,2 cases were grade B,4 cases were grade C,6 cases were grade D,4 cases were grade E;the time between injury and operation ranged from 4 to 12 days. The operation time,bleeding during operation and postoperative drainage volume were observed in two groups,and the changes of nerve function of ASIA grade,clinical efficacy,improved degree of thoracic and lumbar lordosis,and bony fusion were compared between two groups.Results:All patients were followed up from 12 to 24 months with an average of (15.8±3.3) months. The operation time,bleeding during operation,and postoperative drainage volume had no significant different between two groups(P>0.05). As compared with preoperative,ASIA grade of two groups at last follow-up had statistically significantly different(P<0.01),the neural function of two groups after operation was recovered for different extent. The JOA score of two groups was compared between last follow-up and preoperative,the difference had statistically significant (P<0.01),the two groups showed good clinical effect. The clinical results of ASIA grade,JOA score and RIS had no significant differences between two groups. All patients of two groups were obtained fusion. Thoracic and lumbar lordosis angle improvement degree had no significant difference between two groups,it had significant difference had statistical significance compared with preoperative,the two approaches could effectively restore the spinal sequence.Conclusion:For patients with thoracolumbar burst fracture just treated by anterior decompression and reconstruction of anterior column,according to the degree of operation performer'skill proficiency and the patient' condition to choose,but for patients must performed the spinal canal decompression anterior and posterior,the three column reconstruction to required anterior-posterior approach,the posterior unilateral approach corpectomy fusion screw-rod fixation obviously shorten operation time,reduce the operation wound,it is worth the clinical promotion