胸腰段骨折后正中单切口360°椎管减压椎体间植骨内固定术的临床观察

目的：探讨后正中单切口360。椎管减压椎体间植骨后路椎弓根螺钉内固定术治疗严重胸腰段骨折伴脊髓压迫症的安全性及有效性。方法：自2009年1月至2010年3月，从收治的108例胸腰椎骨折病例中选取硬膜前后方均有骨性压迫的胸腰段骨折5例患者，男2例，女3例；年龄23-72岁；损伤部位：T12 2例，L，2例，k1例。采用后正中单切口经椎弓根入路360°椎管减压椎体间植骨后路椎弓根螺钉内固定术治疗。记录手术时间、术中出血量、术后24hVAS评分及吗啡用量、手术前后神经功能Frankel／ASIA分级。结果：所有病例获得随访，时间12～18个月，平均14．6个月。手术时间3．1~6．2h；术中出血量1000～2300ml；术后24hVAS评分为1～4分；术后24h吗啡用量为28．8—30．8mg。Frankel／ASIA等级：术前B级1例，C级2例，D级1例，E级1例；术后E级4例，1例从B级提高到D级。结论：后正中单切口360°椎管减压椎间植骨椎弓根螺钉内固定术治疗胸腰段严重骨折是安全、有效的，术后疼痛较轻、并发症较少。

Single midline posterior approach for 360° decompression and internal fixation with interbody bone graft fusion for severe thoracolumbar spinal fractures

Objective: To discuss the safety and effectiveness of the single midline posterior approach for 360° decompression and instrumented stabilization with interbody bone graft fusion for treatment severe thoracolumbar spinal fractures accompanied with spinal compression. Methods: From January 2009 to March 2010,5 consecutive cases with severe thoracolumbar spinal fracture of totally 108 spinal fracture cases underwent a single midline posterior approach surgery. There were 2 males and 3 females,aged from 23 to 72 years old. Two cases had both T12 and L1 fractures,and 1 case had L1 fracture. The length of the surgical procedure,estimated intra-operative blood loss,VAS score and dosages of morphine at the first 24 hours after operation,the peri-operative complications were recorded. Results: Five patients were follow-up from 12 to 18 months with an average of 14.6 months. The operative time was 3.1 to 6.2 hours. The blood loss was 1 000 to 2 300 ml. VAS score at the first post-operative 24 hours was 1 to 4. The dosage of morphine of the first post-operative 24 hours was 28.8 to 30.8 mg. The preoperative Frankel/ASIA grade was grade B in 1 case,C in 2 cases,D in 1 case and E in 1 case,the post-operative Frankel/ASIA grade was E in 4 cases and D in case. No serious peri-operative complications were found. Conclusion: The single midline posterior approach is a safe and effective surgical approach for 360° decompression and instrumented stabilization with interbody bone graft fusion for severe thoracolumbar spinal fractures with less post-operative pains and complications.