一期后路椎管减压、椎间植骨内固定术治疗胸、腰椎爆裂性骨折的临床观察

目的探讨后路经椎根、椎管减压,椎间植骨内固定术治疗胸、腰椎爆裂性骨折中的临床疗效。方法收集该科2009年1月至2010年2月应用经后路椎体次全切、钛网植骨重建、椎弓根螺钉内固定技术治疗胸、腰椎爆裂性骨折患者16例,其中,男9例,女7例;年龄23～55岁。T12骨折5例,L1骨折7例,L2骨折4例。Denis分型均为爆裂性骨折,其中:A型4例、B型8例、D型3例、E型1例;Frankel分级:A级6例,B级2例,C级5例,D级2例,E级1例。结果术后评估神经恢复情况和伤椎Cobb角矫正情况。结果手术顺利,术后无神经症状加重及相关并发症发生。13例患者随访1年以上,3例失访。末次随访伤椎Cobb角8°～16°,平均8.6°,4例Frankel A级患者神经功能无明显恢复,其余神经功能均有不同程度恢复。结论经一期后路骨折减压、椎间植骨内固定手术创伤小、手术时间短、减压充分,在治疗胸、腰椎爆裂性骨折中具有较好的优势。

Clinical observation of posterior decompression,interbody bone grafting and internal fixation for treatment of thoracolumbar burst fracture in one stage

Objective To investigate the management and clinical effect of subtotal corpectomy and three-column stabilization through posterior approach for thoracolumbar burst fractures.Methods Sixteen cases(9 males,7 females) with the thoracolumbar burst fractures in the hospital from Jan 2009 to Feb 2007,were treated with posterior subtotal resection of vertebral body,implantation of titanium cage reconstruction,and pedicle screw internal fixation.The group age was from 23 to 55 years old.The site of the fracture were T12 in 7 cases,L1 in 4 cases,and L2 in 4 cases.According to Denis′ classification,all cases were burst fracture,including:A type 4 cases,B type 8 cases,D type 3 cases,and E type 1 case.Six patients had neurologically complete paralysis,nine incomplete,and one intact.Pre and post operative neurological status,the correction and loss of Cobbs angle were evaluated.Results All patients during and after surgery were without severe complications,and postoperative clinical symptoms improved significantly.13 patients were observed for more than 1 years.Three patients were lost in observed.Last follow-up vertebral Cobb angle was 8°-16°(mean 8.6°).Four patients Frankel A Grade of neurological function were with no significant recovery,and the rest had varying degrees of neurological recovery.Conclusion The subtotal corpectomy and three-column stabilization through posterior approach for thoracolumbar burst fractures,surgery time is short,and three-column injury in the treatment of thoracolumbar fractures is with satisfactory clinical results.