腰1椎体爆裂骨折改良手术入路的临床应用

目的分析L1椎体爆裂骨折改良前入路手术在临床的应用及效果。方法采用改良前入路手术治疗97例新鲜L1椎体爆裂骨折，依第12肋走向切口，起于第11肋椎关节，止于腋中线；将膈肌与胸膜囊之复合结构于第12肋骨床下缘切开，显露T12、L1、2椎体侧面，行Pyramesh钛网融合器植骨、Z—plate钛板内固定。结果失血量400～1100ml，平均650ml；手术时间2．5～3．5h，平均2．7h；术后未发现内固定松动、断裂、变形，未发现植骨区骨吸收、塌陷及不稳现象。7例术后出现左腹股沟区麻木，1例5个月后伤口感染化脓，妥善处理后痊愈。结论L1椎体骨折改良前入路手术可明显减少手术创伤及出血量，节省了手术时间，同时也提供了坚强的内固定及即刻的稳定，为患者术后康复提供了良好的条件。

Modified Anterior Approach of L1 Burst Fracture in Clinical Application

Objective To analyze the modified anterior approach of L1 burst fracture in the clinical application and effects.Methods From January 2002 to May 2006,97 patients with L1 burst fracture were treated with this method.The incision was along the 12th rib inferior margin,beginning at the rib-vertebral joint,stopping at the axilla midline.The complex of diaphragm and pleura bursa were dissected under the margin of the 12th rib,and was separated from the wall of ventro-thorax.The T12,L1 and L2 vertebra were exposed.The Pyramesh titanium mesh grafted with self bone of the injured L1 vertebra and the 12th rib was put in the spacing,and the Z-plate was fixed in the T12 vertebra and L2 vertebra in the end.Results The blood loss quantity was 650 ml (range 400 to 1 100 ml).The operation time was 2.7 hours (range 2.5 to 3.5 hours).Neither fixation flexibleness,break,distortion of the plate and screws,nor bone-absorption,subsiding and instability occurred.Seven patients had groin area numbness.One patient had wound infection after five months and healed after proper disposal. Conclusion The modified anterior approach of L1 burst fracture could reduce the operation injury and blood loss quantity significantly, saving the operation time, giving rigid fixation and immediate-stabilization.