前路减压与稳定性重建治疗胸腰椎爆裂骨折并截瘫

目的：探讨胸腰椎爆裂骨折并截瘫早期前路减压与稳定性重建术的临床价值。方法：采用经第12肋胸膜外-腹膜后入路、将伤椎次全切除，并切除伤椎上、下的椎间盘，硬脊膜前方减压，纵向大块植骨及应用椎体间固定器作内固定，治疗胸腰椎爆裂骨折96例。结果：所有病例平均随访4．2年。术后植骨块融合良好，无脊髓神经根再损伤及继发后凸畸形，87．5％的病人获Frankel分级1级以上的功能恢复。结论：脊柱胸腰段爆裂骨折伴截瘫，前路手术能作到直接彻底的脊髓神经减压，前路重建符合脊柱的生物学特征。

Anterior Decompression and Stabilization for Treatment of Thoracolumbar Burst Fractures combined with Neurological Deficits

Objectives:To study the methods and effects of treatment of thoracolumbar burst fractures combined with neurological deficits via anterior decompression and stabilization. Methods:Ninety-six cases of thoracolumbar fractures were treated with anterior decompression, inter-vertebral bone grafting, and short segment fixation devices by extrapleural and retroperitoneal approach. Results:All cases were followed up for an average of 4.2 years. Good fusions of the grafts were obtained. There was no root damage or post-trauma kyphosis. The neurological functions for 87.5% patients were improved by more than one grade (Frankel Grade). Conclusions: Anterior approach for burst fracture of T11?T12?L1?L2 with neurological damage can obtain a direct and complete decompression. Anterior stabilization conforms to the principles of spinal biomechanics.