后路部分椎体切除治疗合并神经损伤的难复性下腰椎爆裂性骨折

目的探讨后路部分椎体切除治疗合并神经损伤的难复性下腰椎爆裂性骨折的疗效。方法回顾性分析2014年3月-2018年10月收治的28例合并神经损伤的难复性下腰椎爆裂性骨折患者临床资料,载荷分享评分(LSC)6~9(7.2±1.1)分;高处坠落伤7例,交通伤15例,重物砸伤6例;L3骨折18例、L4骨折7例、L5骨折3例,其中6例合并邻近椎体压缩性骨折;马尾神经损伤10例,神经根损伤4例,两者均有损伤14例;受伤至手术时间2~7(3.4±1.4)d。记录手术时间、术中出血量,对疼痛视觉模拟量表(VAS)评分、伤椎椎体前缘高度比、Cobb角及神经功能美国脊髓损伤协会(ASIA)分级改善情况进行评价。结果所有手术均顺利完成,手术时间(163.9±22.4)min,术中出血量(652.1±95.5)mL。所有患者随访12~30个月,平均16.7个月。术后VAS评分、伤椎椎体前缘高度比和Cobb角均较术前显著改善,差异有统计学意义(P<0.05)。神经功能ASIA分级,术前A级1例术后仍为A级;术前B级4例,术后恢复至C级3例、D级1例;术前C级15例,术后恢复至D级11例、E级4例;术前D级8例,术后仍为D级4例,恢复至E级4例。结论后路部分椎体切除治疗合并神经损伤的难复性下腰椎爆裂性骨折疗效满意。

Posterior partial corpectomy for treatment of irreducible lower lumbar burst fracture combined with nerve injury

Objective To investigate the effect of posterior partial corpectomy in the treatment of irreducible lower lumbar burst fracture combined with nerve injury. Methods From March 2014 to October 2018,the clinical data of 28 patients with irreducible lower lumbar burst fracture combined with nerve injury were analyzed retrospectively,with load sharing score(LSC) of 6-9(7.2±1.1);high fall injury in 7 cases,traffic injury in 15,bruise injury in 6;L₃ fracture in 18 cases,L₄ fracture 7,L₅ fracture 3,including 6 with compression fracture of adjacent vertebral body;cauda equina injury in 10 cases,nerve root injury 4,both cauda equina and nerve root injury 14. The time from injury to operation was 2-7(3.4±1.4)d. Operation time,intraoperative blood loss,visual analogue scale(VAS) score,ratio of injured vertebral anterior edge height,Cobb''s angle and American Spinal Injury Association(ASIA) neurological function classification were evaluated. Results All the operations were completed successfully. The operation time was (163.9±22.4)min,and the intraoperative blood loss was (652.1±95.5)mL. All the patients were followed up for 12-30 months,with an average of 16.7 months. The postoperative VAS score,ratio of injured vertebra anterior edge height and Cobb''s angle were significantly improved compared with those at pre-operation,all with a statistical significance(P<0.05). According to ASIA classification,1 patent with grade A at pre-operation was still in grade A;of 4 patient with grade B at pre-operation,3 recovered to grade C,1 to grade D;of 15 patient with grade C at pre-operation,11 to grade D,4 to grade E;8 with grade D at pre-operation,4 still in grade D,4 to grade E. Conclusion The effect of posterior partial corpectomy for the treatment of irreducible lower lumbar burst fracture combined with nerve injury is satisfactory.