间接减压经椎弓根植骨在胸腰椎爆裂骨折中的应用价值

目的比较在胸腰椎爆裂骨折中后路间接减压经椎弓根植骨与开放减压后外侧植骨2种手术方法的临床疗效。方法回顾性分析1998年4月—2008年3月所收治的胸腰椎爆裂骨折并经完整随访的患者56例,将其分为2组:间接减压组32例,于伤后早期(72 h内)经后路行短节段椎弓根钉棒系统复位固定、间接减压,经伤椎椎弓根植入自体松质骨浆;开放复位组24例,行半椎板或全椎板切除,短节段椎弓根螺钉系统内固定,半椎板、横突或关节突融合。观察2组手术中的情况及并发症,评价各组在脊柱的矫形、Cobb角的矫正及神经功能恢复情况。结果2组手术时间分别为1.81 h、2.23 h,出血量为360 mL、440 mL,2组比较均有显著性差异(P均<0.05),全部病例经9~24个月随访,平均15.2个月,2组患者术前、术后脊髓功能Frankel分级、椎体前缘压缩率、Cobb角均无显著性差异(P均>0.05),术前2组脊髓功能恢复、椎体畸形的矫正率、Cobb角的矫正率比较均无显著性差异(P均>0.05),而2组术后脊髓功能均有明显恢复,Frankel分级分别提高1~4级,4例脊髓完全损伤者神经功能Frankel分级提高1级、2级,椎体前缘压缩率、Cobb角的矫正均明显好转(P均<0.05),全部病例基本达解剖复位,术后无内固定物失败,内固定物取出后矫正丢失率分别为0.8%,8.6%。结论后路器械复位间接减压能有效提供神经修复空间,经椎弓根植骨可有效降低内植物的失败及矫正度的丢失,同时能够缩短手术时间,减少出血量,是治疗胸腰椎爆裂骨折的可靠有效方法。

Value of indirect decompression and bone graft through pedicle of vertebra arch on thoracic-lumbar burst fracture

Objective It is to compare the clinical curative effect of indirect decompression and bone graft through pedicle of vertebra arch and direct decompression and post-anteral bone graft on thoracic-lumbar burst fracture.Methods Fifty-six cases of thoracolumbar fractures were treated in our hospital from April 1998 to March 2008 and divided into two groups.32 cases were in indirect decompression group and underwent posterior exposition,reduction and fixation with pedicle screws and bone-grafted in vertebra body through pedical vertebra in the short time after trauma(in 72 h).24 cases were in open decompression group and treated with posterior hemi-laminectomy of full-laminectomy,internal fixation with pedicle screws and fusion of jhemi-lamina of transverse process or atricular process.The perioperative data and complications in the two groups were analyzed.The reshaping of vertebral column,Cobb angle and neural function recovery information were evaluated.Results The operation time and bleeding quantity were 1.81 h and 360 mL respectively in indirect decompression group,and 2.23 h and 440 mL in direct decompression group.There were significant difference between the two groups(P<0.05).All cases received 9 to 24 months follow-up(mean 15.2 months).There were no differences on Frankel grading,the compression ratio of anterior wall of the vertebral body and Cobb angle before and after operative between the two groups(all P>0.05).There were no differences on spinal cord function recovery information,the rate of correction vertebra deformity and Cobb angle correction rate before operative between the two groups(all P>0.05).After operation,the spinal cord function recovered obviously,Frankel grading respectively raised 1 to 4 grades in 29 incomplete spinal cord injuries,and 1 or 2 grades in four complete spinal cord injuries in two groups.All cases achieved nearly anatomic reduction,no implant failure,and the correction loss after the implants removed was 0.8% in indirect decompression group and 8.6% in direct decompression group.Conclusion Indirect decompression and instrumentation reduction through posterior approach can effectively provide space for neural plerosis.Bone grafting through pedicle of vertebra arch can obviously lower implant failure and the correction loss,at the same time it can shorten operation time and decrease the blood loss,which is reliable and effective therapy for thoracic-lumbar burst fracture.