侧前方Ventrofix加钛网植骨固定治疗胸腰椎爆裂性骨折

目的：探讨前路Ventrofix加钛网植骨固定在治疗严重胸腰椎爆裂性骨折中的应用价值和疗效。方法：2008年1月至2010年1月对严重胸腰椎爆裂性骨折21例患者，应用侧前方入路行椎体部分切除减压，椎体间钛网加自体骨植骨及Ventrofix内固定手术治疗，男15例，女6例；年龄21～46岁，平均32．2岁。骨折节段：Tn3例，T126例，L17例，L25例。平均脊柱后凸角20．1.骨折载荷分享评分平均7．8分。21例均伴有不完全性瘫痪。采用Frankel分级观察神经功能恢复情况；通过影像学资料观察后凸角矫正、维持和内固定情况。结果：21例均获得随访，时间12～34个月，平均18．5个月。术后1例出现胸膜损伤，2例出现动力性肠梗阻，1例髂腹股沟神经损伤，1例切口愈合不良，对症治疗后均治愈。融合节段平均后凸角4．2。，矫正率79％。末次随访时21例患者神经功能均有不同程度恢复；影像学检查显示椎管管腔恢复正常，无内固定失败，矫正度无明显丢失，钛网无移位，螺钉无松动、断裂及退出现象，植骨均获得良好融合。结论：胸腰椎侧前方减压、椎体间钛网加自体骨植骨及Ventrofix内固定是治疗严重胸腰椎骨折的理想方法之一．但时于存在严重骨盾疏松患者．避赍．应用．

Treatment of thoracolumbar burst fracture with lateral anterior decompression, internal fixation with Ventrofix and bone graft with titanic mesh

Objective: To discuss the efficacy of lateral anterior decompression, internal fixation with Ventrofix and bone graft with titanic mesh in the treatment of severe thoracolumbar burst fracture. Methods: From January 2008 to January 2010, 21 patients with severe thoracolumbar burst fracture were treated with lateral anterior decompression, internal fixation with Ventrofix, bone graft with titanic mesh. There were 15 males and 6 females, ranging in age from 21 to 46 years with an average of 32. 2 years. Segment of fracture:3 cases were in T₁₁, 6 cases in T₁₂, 7 cases in L₁, 5 cases in L₂. The mean kyphosis angle was 20. 1° and loading of fracture was 7. 8 scores. Twenty-one cases accompany with incomplete paralysis. Nerves functions were observed according to Frankel grade;correction and maintain of kyphosis angle were observed by X-rays and CT. Results: All the patients were followed up from 12 to 34 months with an average of 18. 5 years. Postoperative complication including injury of pleura in 1 case, dynamic ileus in 2 cases, ilioinguinal nerve injury in 1 case, faulty union of wound in 1 case. All the above complications got recovery after symptomatic treatment. The mean kyphosis angle in fusional segment were 4. 2° and the rate of correction was 79%. Nerves functions of all patients got improvement and no internal fixation fail, kyphosis angle obviously lost, titanium mesh shifting, loosening and breakage of screw were found at final follow-up. Conclusion: Lateral anterior decompression, bone graft with titanic mesh, internal fixation with Ventrofix is an idea technique for severe thoracolumber burst fracture, but the method can not be used for patient with severity osteoporosis.