胸腰段严重爆裂性骨折和陈旧性骨折后凸畸形的改良手术治疗

目的评价治疗胸腰段严重爆裂性骨折和陈旧性骨折后凸畸形的两种改良的手术方式。方法第1组,新鲜胸腰段严重爆裂性骨折12例,行单纯后路伤椎全椎切除,360°稳定性重建治疗。第2组,胸腰段陈旧性骨折后凸局部畸形8例,行单纯后路经椎弓根截骨矫正。全部病例均经过1年以上随访,比较术前、术后X线片,测量胸腰段Cobb角的变化,对脊髓损伤的患者采用Frankel分级评分。结果经12~24个月随访,第1组、第2组Cobb角分别由术前平均38.6°、28.8°恢复为术后平均5.5°、8.6°。第1组中全部病例存在脊髓损伤,患者Frankel分级平均提高1.5级。第2组术后Frankel分级平均提高1级。无椎弓根钉松动、断裂发生。结论针对胸腰段严重爆裂性骨折和陈旧性骨折后凸畸形的两种改良的手术治疗方式为临床医师提供了新的思路。

Innovative surgical treatment for severe thoracolumbar burst fracture or obsolete traumatic kyphosis

Objective To evaluate two innovate operative methods for severe thoracolumbar burst fracture and obsolete traumatic kyphosis. Methods Group 1: twelve thoracolumbar burst fracture patients underwent single stage posterior transpedicular vertebra column resection and circumferential reconstruction. Group 2: eight obsolete traumatic kyphosis caused by thoracolumbar fracture underwent single stage posterior transpedicular wedge osteotomy. All patients were followed up over one year. Preoperative and postoperative X-ray film were compared and Cobb angle of thoracolumbar spine changes were recorded. The patients of spinal cord injury were evaluated by Frankel scoring. Results The Cobb angle of two groups were improved from 38.6° and 28.8° to 5.5° and 8.6° respectively. All patients in Group 1 with spinal cord injury, whose Frankel score improved 1.5 grade. Frankel grade of Group 2 improved mean one. No pedicle screw loosen, broken occurred. Conclusion The two innovate operative methods for severe thoracolumbar burst fracture and obsolete traumatic kyphosis provide a new choice for spine surgeon.