前后联合入路治疗腰椎三柱不稳定型骨折

目的 探讨前后联合入路治疗严重腰椎三柱不稳定型骨折的临床疗效.方法 回顾性分析手术治疗的6例腰椎三柱不稳定型骨折(L_1骨折3例,L_2骨折1例,L_3骨折2例)患者的临床资料.采用后路减压椎弓根螺钉固定结合前路椎体次全切除椎体间植骨融合内固定术.用ASIA标准评定神经功能恢复情况,通过影像学检查比较伤椎和后凸畸形角的矫正及丢失,评估手术疗效情况.结果 随访7～18个月,6例患者术后神经功能,根据美国脊柱脊髓损伤学会(ASIA)分级均恢复1级或1级以上.术前后凸畸形角为30.5～44.6度,术后即刻为3.5～13.2度(P<0.05).术前CT显示椎管内骨块占椎管容积49%～94%,术后<20%(P<0.05).术前伤椎前、后缘高度分别压缩40%、66%,术后为97%、99%(P<0.05).植骨完全融合,融合时问为3～5个月.结论 前后联合入路治疗严重腰椎三柱不稳定性爆裂骨折,可有效恢复椎体高度、腰椎前凸及椎管容积,促进患者功能恢复.

Treatment of severe lower lumbar burst fracture by combined anterior and posterior approach

Objective To analyze the outcomes of treating severe lower lumbar burst fracture by combined anterior and posterior approach. Methods The data of 6 cases with severe lower lumbar burst fractures(L1 in 3 cases, L2 in 1 case, L3 in 2 cases) were reviewed retrospectively. All patients underwent posterior reduction, transpedicle screw internal fixation combined with anterior decompression and bone graft, who were followed up for 7 to 18 months. Results Postoperative neurological status was evaluated as ASIA grade 1 or more in 6 cases with preoperative incomplete paraplegia. The lumbar lordosis angles were significantly decreased after ooperation (30. 5-44. 6) degrees vs. (3. 5-13. 2) degrees] (P<0. 05). So did the spinal canal volume (49%-94%) vs. <20%] (P<0. 05). The height of anterior and posterior edge was 40% and 66% before operation, which were increased to 97% and 99% respectively immediately after the operation (P<0. 05). The bone grafts fused completely within 3 to 5 months. Conclusion Treatment of severe lower lumbar burst fracture by combined anterior and posterior approaches is effective in restoration of intervertebral body height, lumbar lordosis and spinal canal volume.