经椎间孔减压椎间融合术治疗胸腰椎骨折脱位的临床及影像学结果分析

目的:评价经椎间孔减压椎间融合治疗胸腰椎骨折脱位的临床及影像学结果。方法:回顾性分析2010年6月至2017年6月采用后路经椎间孔减压、椎间植骨融合联合后方椎弓根螺钉治疗21例胸腰椎骨折脱位患者的临床资料,其中男15例,女6例;年龄25～58岁,平均45岁。术前ASIA神经功能损伤分级,A级3例,B级7级,C级6例,D级4例,E级1例。记录手术时间、术中出血量及相关并发症。评价术前及术后的VAS评分、ODI及Cobb角。分析末次随访的神经功能改善情况。通过CT三维重建评价椎间植骨融合情况。结果:手术时间150～240(192±47)min;术中出血量380～750(603±120)ml。术中发现3例由外伤导致的硬膜囊撕裂及脑脊液瘘,均给予缝合修补;1例术后浅表伤口感染,经换药后愈合。术后随访24～45(37.0±9.5)个月。患者的VAS评分由术前的8.9±0.4降低至术后即刻的4.2±1.3(P0.05)。至末次随访时,VAS评分进一步降低至3.6±0.8。ODI由术前的(95.30±3.52)%降低至末次随访时的(32.51±6.30)%(P0.05)。Cobb角由术前的(21.2±8.8)°矫正至术后即刻的(2.3±3.1)°(P0.05)。至末次随访时,Cobb角为(3.2±2.5)°,与术后即刻相比差异无统计学意义。至末次随访时,ASIA神经功能分级为A级3例,B级3例,C级5例,D级6例及E级4例。21例患者均获得良好的椎间植骨融合,融合时间为8～13(10.3±2.5)个月。结论:对于主要累及椎间盘及终板平面的胸腰椎骨折脱位,采用后路经椎间孔减压椎间融合术治疗不仅手术创伤小,而且能够有效的重建三柱结构及获得良好的生物力学稳定性,此外术后神经功能恢复良好。

Clinical and radiological results of thoracic and lumbar fracture and dislocation treated with posterior transforaminal decompression and interbody fusion

Objective:To evaluate the clinical and radiological results of patients with thoracic and lumbar fracture and dislocation treated by posterior transforaminal decompression and interbody fusion.MethodsFrom June 2010 to June 2017,posterior transforaminal decompression,interbody fusion combined with pedicle screw fixation were performed in 21 patients with thoracic and lumbar fracture and dislocation. Their clinical and radiological data were collected and retrospectively analyzed,including 15 males and 6 females,aged from 25 to 58 years with an average of 45 years old. According to the criterion of American Spinal Injury(ASIA),preoperative neurological function was graded A in 3 cases,B in 7 cases,C in 6 cases,D in 4 cases and E in 1 case. Operative time and intraoperative blood loss and correlative complications were recorded. And VAS score,ODI and Cobb angle were evaluated before and after surgery. The improvement of neurological function was also analyzed at the final follow-up. Intervertebral bony fusion was observed during the follow-up by CT three-dimensional reconstruction.ResultsThe operative time was 150 to 240 min with an average of (192±47) min. The intraoperative blood loss was 380 to 750 ml with an average of(603±120) ml. Dura sac tearing and cerebral fluid leakage occurred in 3 cases and were repaired during operation;superficial wound infection occurred in 1 case,and got healing after dressing change. The postoperative follow-up duration was 24 to 45 months with an average of(37.0±9.5) months. VAS score was improved from preoperative 8.9±0.4 to immediately postoperative 4.2±1.3(P<0.05). At the final follow-up,VAS score decreased further to 3.6±0.8. ODI was decreased from preoperative (95.30±3.52)% to (32.51±6.30)% at the final follow-up (P<0.05). Cobb angle was corrected from preoperative (21.2±8.8)° to immediately postoperative(2.3±3.1)° (P<0.05). At the final follow-up,Cobb angle was (3.2±2.5)°,showing no significant difference with immediately postoperative value. The neurological function was grade A in 3 cases,B in 3 cases,C in 5 cases,D in 6 cases and E in 4 cases at the final follow-up. All the patients got solid intervertebral bone fusion in 8 to 13 months after operation,with an average fusion time of (10.3±2.5) months.ConclusionFor the patients with thoracic and lumbar fracture and dislocation mainly involving intervertebral disc and endplate plane,posterior transforaminal decompression and interbody fusion not only is less invasive,but also can effectively reconstruct spinal three column and obtain good biomechanical stability. And,it is beneficial for the good recovery of neurological function.