严重腰椎骨折合并椎体前方与侧方完全性脱位的后路复位与固定

目的 探讨后路椎弓根系统治疗严重腰椎骨折合并前方与侧方完全性脱位的方法与疗效.方法 2005年3月至2010年5月收治12例严重腰椎骨折合并椎体前方及侧方完全性脱位患者,男11例,女1例；年龄18 ～52岁,平均31.3岁；主要损伤节段:L1 9例,L2 3例；骨折按AO分型均为C3型；术前脊髓神经功能按Frankel分级:A级8例,B级4例.所有患者均采用后路椎弓根螺钉系统进行三维矫正与固定,并进行彻底的椎管前后减压、椎间及后路植骨融合.结果 所有患者术后获7个月至5年3个月(平均2.6年)随访.手术时间为120～ 240 min,平均160 min；出血量为500 ～1200 mL,平均700 mL.椎体骨折及向前方及侧方完全性脱位的椎体均实现良好复位,8例Frankel A级术后1例恢复至C级,3例恢复至B级,4例无明显恢复,4例B级患者2例恢复至C级,2例恢复至D级.植骨面均获骨性融合,无内固定物松动、断裂等并发症发生.结论 对于严重的腰椎骨折合并椎体向前方与侧方完全脱位患者,采用后路椎弓根系统可实现重度椎体骨折脱位的良好复位与固定,且同一入路可完成椎管前、后减压与植骨.

Posterior surgery for severe lumbar fracture and complete rotational dislocation by transpedicle screw system

Objective To evaluate the posterior surgery for severe lumbar fracture and complete rotational dislocation by transpedicle screw system.Methods A retrospective review was done for 12cases of severe lumbar fracture and complete rotational dislocation who had been surgically treated from March 2005 to May 2010.They were 11 nen and one woman,aged from 18 to 52 years (average,31.3 years).By AO classification,they were of type C3.LI was involved in 9 cases and L2 in 3 cases.By preoperative Frankel grading,there were 8 cases of Grade A and 4 cases of Grade B.They underwent open reduction and fixation with transpedicle screw system through a posterior approach,complete anterior and posterior decompression of the vertebral canal and inter-vertebral and posterior grafting and fusion.Results All patients had a successful operation,with a mean operation time of 160 minutes(from 120 to 240 minutes) and a mean blood loss of 700 mL (from 500 to 1200 mL).Their follow-ups averaged 2.6 years (from 7 months to 5 years and 3 months).Postoperative X-ray showed that the complete dislocations were reduced in all patients.Of 8 patients with Frankel Grade A,one improved to Grade C,3 to Grade B and 4 had little improvement; of 4 patients with Frankel Grade B,2 improved to Grade C and 2 to Grade D.No loosening,dislocation or breakage of the internal implants occurred in the follow-up period.Conclusion Fine reduction and fixation,as well as anterior and posterior decompression and grafting,can be accomplished through the posterior approach by transpedicle screw system for severe lumbar fracture and complete rotational dislocation.