开窗减压术联合置钉复位内固定术治疗胸腰椎爆裂性骨折的临床观察

目的 研究开窗减压术联合置钉复位内固定术对胸腰椎爆裂性骨折的临床疗效.结果 将2013年1月至2016年1月本院收治的65例胸腰椎爆裂性骨折病例纳为研究对象,均予以开窗减压术联合置钉复位内固定术治疗方案,观察患者手术前后椎体高度、后突角(Cobb's角)、Oswestry功能障碍与神经功能变化、骨折愈合与并发症情况.结果 术后l周,椎体高度从术前(55.18±3.47)％增加到(92.47±3.96)％,差异有统计学意义(P＜0.05),术后12个月椎体高度没有明显丢失(P＞0.05);术前患者Cobb's角为(33.86±4.25)°、Oswestry指数为(87.23±2.05)％,术后1周明显降低,分别为(21.53±2.54)°、(27.45±1.28)％(均P＜0.05),且在之后12个月未发生明显变化(P＞0.05);术后12个月,Frankel A级、B级与C级均明显减少,D级与E级明显增多(P＜0.05);患者全部获骨性愈合,并且没有内固定断裂或者松动等并发症出现.结论 对胸腰椎爆裂性骨折患者实施开窗减压术联合置钉复位内固定术方案,可获得良好骨折愈合效果,有效恢复椎体高度并且纠正后突畸形,促进神经功能恢复,术后并发症少,安全性高,具有积极推广意义.

Fenestrating decompression combining screw restoration and internal fixation in treatment of thoracolumbar burst fracture

Objective To study the clinical effect of fenestrating decompression combining screw restoration and internal fixation in the treatment of thoracolumbar burst fracture.Methods From Jan.2013 to Jan.2016,65 patients with thoracolumbar burst fracture treated at our hospital were taken as clinical research objects and all the patients were treated with fenestrating decompression combining screw restoration and internal fixation.The vertebral height,posterior process angle (Cobb's angle),Oswestry dysfunction index,nerve function changes,fracture healing,and complications before and after the treatment were observed.Results 1 week after the operation,the vertebral height increased from (55.18±3.47)％ before the operation to (92.47±3.96)％,with a statistical difference (P＜0.05).12 months after the treatment,there was no significant loss in the vertebral height (P＜0.05).1 week after the operation,the Cobb's angle and Oswestry index significantly decreased from (33.86±4.25)° and (87.23±2.05)％ before the operation to (21.53±2.54)° and (27.45±1.28)％ (both P＜0.05) and there were no obvious changes in following 12 months (P＞0.05).12 months after the operation,Frankel A,B,and C levels were significantly reduced,but D and E levels increased significantly (P＜0.05).All the patients got bone union.There were no complications such as rupturing or loosening of internal fixation.Conclusions Fenestrating decompression combined with screw restoration and internal fixation has good fracture healing effect in the treatment of thoracolumbar burst fracture,can effectively restore the height of vertebral body,correct the kyphosis,and promote the recovery of nerve function.Because of its fewer complications and higher safety,it is worth being generalized.