经后路一期前路减压重建后路固定治疗严重胸腰椎爆裂骨折的临床观察

目的探讨经后路一期前路减压重建后路固定治疗严重胸腰椎爆裂骨折的临床效果。方法总结2006年~2009年经后路一期前路减压重建后路固定治疗严重胸腰椎爆裂骨折12例患者,男8例,女4例,年龄24~56岁,AO分型B3型7例,C3型5例,脊髓损伤Frankel分级,A级3例,B级5例,C级4例。经后路一期手术,椎弓根螺钉系统固定,经椎弓根椎体次全切除,椎管减压,钛网融合器前柱重建。术后随访患者脊髓神经功能恢复和植骨融合情况,术前和术后Coob角度比较评估手术效果。结果 12例患者均得到随访,随访时间2~4年。术后神经损伤症状无加重,神经功能均有好转,椎体高度无丢失,无钉棒松动断裂发生。结论经后路一期前路减压重建后路固定手术治疗严重胸腰段脊柱爆裂骨折效果可靠、安全,可做为治疗严重胸腰椎爆裂骨折的一种方法。

The clinical observation of severe thoracolumbar burst fracture via one stage posterior approach operation for anterior column decompression, reconstruction and posterior fixation

Objective To investigate the clinical therapeutic effect of severe thoracolumbar burst fracture via one stage posterior approach operation for anterior column decompression, reconstruction and posterior fixation. Methods 12patients （8 males ＆ 4 females） aged between 24 to 56 year-old with severe thoracolumbar burst fracture were classified as B3 （7 cases） and C3type （5 cases） according to the AO classification. They were also categorized as A type （3 case）, B type （5 cases）, and C type （4 cases） according to the Frankel grade for spinal cord injury. All patients accepted the one stage posterior approach operation with pedicle screw fixation, transpedicular subtotal corpectomy, spinal canal decompression, and anterior column reconstruction using titanium mesh cage. The neurological recovery, grafting bone fusion status and the Cobbs angle were evaluated pre- and post-operation. Results After 2-4 years post-operation, the symptoms of neurological damage from all patients did not deteriorate; neurological functions got a significant recovery; there was no loss of the vertebral body height; the fracture and looseness of pedicle screw system were not observed. Conclusion This therapeutic method for thoracolumbar fracture is reliable and safe for clinical treatment for thoracolum- bar burst fracture.