一期前后入路治疗胸腰椎严重爆裂性骨折临床效果分析

目的探讨一期前后联合入路治疗胸腰椎严重爆裂性骨折合并脊髓及神经损伤患者的临床疗效。方法 2008年2月～2012年1月本院骨科行一期前后入路手术治疗胸腰椎严重爆裂性骨折合并脊髓及神经损伤患者共18例,分析一期前后联合入路的优缺点、适应证和临床效果。结果本组患者椎管均获得有效减压,平均随访（13.6±3.6）个月,植骨块融合良好,伤椎高度基本恢复。Cobb角由术前平均18°恢复到3°。Flankel分级恢复1级者7例,2级者6例,无变化者5例。结论一期前后联合入路手术是治疗胸腰椎严重爆裂性骨折合并脊髓及神经损伤的有效方式,是集减压、复位内固定、植骨融合一次完成的有效方法,但手术创伤较大,应严格掌握手术适应证。

Clinical effect analysis of one stage anterior-posterior approach in the treatment of severe burst fracture of thoracolumbar spine

Objective To explore the clinical effects of one stage anterior-posterior approach in the treatment of severe burst fracture of thoracolumbar spine combining with nerve injury.Methods Eighteen patients suffered from severe burst fractures of thoracolumbar spine with nerve injuries underwent one stage anterior-posterior approach in our or-thopedics department from February 2008 to January 2012.The advantages and disadvantages,indications,and clinical effects of one stage combined anterior and posterior approach were analyzed. Results The effective decompressions of spinal canal in all patients were obtained.An average of （13.6 ±3.6） months follow-up visits,the bone graft fusion was good,and the injured vertebra height basically recovered.The Cobb angle recovered from average 18 ° pre-operation to 3° .According to Flankel grading recovery,there were 7 cases in grade Ⅰ ,6 cases in grade Ⅱ ,and 5 cases without changes.Conclusion One stage combined anterior with posterior approach is an effective way to treat severe burst fracture of thoracolumar spine combining with spinal cord injury and nerve injury,which accomplishes the decompression, reduction and internal fixation,and bone graft fusion for once.Whereas,the operative wound is much bigger,the surgical indications should be proficiently mastered.