重度腰骶椎创伤性脱位的手术治疗

目的:探讨重度腰骶椎创伤性脱位的手术治疗方案及其效果。方法:回顾性分析2005年1月～2012年7月收治的65例重度腰骶椎创伤性脱位患者的影像学资料特点、手术治疗方案及术后恢复的效果。其中,46例患者行后路减压、椎弓根钉棒系统复位固定及植骨融合;15例患者在后路减压的同时行前路骨折椎体切除及取自体髂骨植骨融合内固定;4例患者单纯行前路减压、固定和植骨融合。结果:所有病例前后脱位均得以纠正,1例侧方脱位未完全纠正。65例骨折椎体高度和形态恢复良好,椎体高度平均恢复19mm(15～25mm),Cobb角均纠正,除7例脊髓圆锥完全性损伤者外,其余患者的临床症状均有不同程度的改善。结论:对于严重的腰骶椎创伤性脱位患者应根据椎体骨折和后部附件损伤的程度以及椎管受压迫的情况而采用不同的手术方案。

Surgical treatment for severe lumbar and (or) sacral vertebrae traumatic dislocation

Objective: To explore the surgical treatment and effect for severe lumbar and (or) sacral vertebrae traumatic dislocation. Methods: Through the retrospective analysis from January 2005 to July 2012, 65 cases of lumbar and(or) sacral vertebrae traumatic dislocation patients imaging characteristics, surgical treatment and postoperative recovery effect. Among them, the 46 patients underwent posterior decompression, through the pedicle-screws and rod to reduction, fixed and planting bone fusion; 15 patients underwent posterior decompression and resection parts of fracture vertebral ,planting ilium bone fusion , internal fixation by anterior; 4 patients underwent anterior decompression, simple fixed and planting bone fusion. Results: All cases were corrected in dislocation sagittal plane, only 1 cases was not completely correct in frontal plane. 65 cases fracture of vertebral body height and form were recovery, injury vertebral height recovery 19 mm (15 mm-25 mm) in average, Cobb Angle are correct, in addition to 7 cases of conus medullaris damaged completely, the rest of patients’clinical symptoms were had improvement in different degrees . Conclusion: For the severe lumbar and (or) sacral vertebrae traumatic dislocation , operation scheme should be based on vertebral fracture , the degree of the damage to vertebral accessories and vertebral canal oppressed situation.