前路骨折椎体后上角切除椎管减压单节段固定融合治疗腰椎爆裂骨折的初期临床结果

目的报道骨折椎体后上角部分切除减压、前路单节段固定融合治疗腰椎爆裂骨折的手术方法和早期临床结果。方法2006年6月～10月,收治4例Denis B型腰椎爆裂性骨折患者,采用骨折椎体后上角部分切除减压、前路单节段固定融合治疗。其中男2例,女2例;年龄17～39岁。均为高处坠落伤,伤后10～12d手术。骨折平面位于L1和L2各2例。术前神经功能评价采用Frankel评分,B、C级各2例,视觉模拟疼痛量表（visual analogue scale,VAS）评分7.00±0.82。影像学评价：X线侧位片测量患者后突畸形的Cobb角为22.94±11.21°;邻近融合节段上下椎间盘高度,分别为上位12.78±1.52mm,下位11.68±1.04mm;CT扫描测量椎管矢状直径为9.56±2.27mm。于术后即刻、术后3个月再次对患者进行神经功能和影像学评价。结果4例前路单节段加压融合固定手术顺利,手术时间平均为166±29min,术中出血量平均为395±54ml。Frankel评分,术后即刻,2例术前B级有1例恢复至C级,1例不变;2例术前C级有1例恢复至D级,1例不变;术后3个月,2例术前B级均恢复至C级,1例C级恢复至D级,另1例C级恢复至E级。VAS评分于术后即刻显著下降至3.50±1.29;术后3个月为1.25±0.50,分别与术前比较差异有统计学意义（P〈0.05）。术后即刻椎管矢状直径较术前扩大至19.76±3.82mm（P〈0.01）;术后3个月为19.27±3.41mm,与术后即刻比较差异无统计学意义（P〉0.05）。术后即刻Cobb角为8.71±5.41°（P〈0.05）;术后3个月为9.52±5.66°,与术后即刻比较差异无统计学意义（P〉0.05）。术后即刻的邻近融合节段上下椎间盘高度分别为10.97±1.44mm和11.65±1.47mm,术后3个月时分别为10.93±1.46mm和11.34±1.45mm,各时间点比较差异均无统计学意义（P〉0.05）。术后即刻及术后3个月内随访患者恢复良好,未出现并发症。术后3个月X线片及CT扫描示内固定位置良好,未发现内固定物松动移位的表现。结论前路单节段减压固定融合技术对于Denis B型骨折能达到脊髓减压的目的,术后早期能够保持脊柱的稳定,但远期效果仍需要进一步随访和观察。

ANTERIOR SINGLE SEGMENTAL DECOMPRESSION AND FUSION TO TREAT LUMBAR BURST FRACTURE

OBJECTIVE: To explore an improved surgical approach to the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion to treat lumbar burst fracture and to evaluate its preliminary clinical application. METHODS: From June to October 2006, 4 patients (2 males, 2 females; age, 17-39 years ) with Denis B type lumbar burst fracture underwent the superior posterior partial resection of the fractured vertebral body followed by the single segmental fusion. The fracture occurred in 2 patients at L1 and 2 at L2. According to the Frankel scales assessment, before operation, 2 patients were at Grade B and the other 2 at Grade C, and the visual analogue scale (VAS) was 7.00 +/- 0.82. Radiological evaluation was performed, which revealed the kyphosis Cobb angel of 22.94 +/- 11.21 degrees, the adjacent superior and the inferior intervertebal disc heights of 12.78 +/- 1.52 mm and 11.68 +/- 1.04 mm, respectively, and the vertebral canal sagittal diameter of 9.56 +/- 2.27 mm on the computer tomography (CT) scan. The neurological and the radiological evaluations were also made immediately and 3 months after operation. RESULTS: The anterior single segmental decompression and fusion operations were performed successfully in all the patients. The average operating time was 166 +/- 29 min and the average amount of blood loss was 395 +/- 54 ml. The Frankel scales assessment showed that at the time immediately after operation, one of the 2 Grade B patients had an improvement to Grade C, but the other patient had no improvement. One of the 2 Grade C patients had an improvement to Grade D, but the other patient had no improvement. Three months after operation, the 2 Grade B patients had an improvement to Grade C. The 2 grade C patients had an improvement to Grade D or E. The VAS score was significantly decreased to 3.50 +/- 1.29 after operation and to 1.25 +/- 0.50 3 months later (P < 0.05). The vertebral canal sagittal diameter was significantly increased to 19.76 +/- 3.82 mm (P < 0.01), but it was maintained to 19.27 + 3.41 mm 3 months later, with no significant difference( P > 0.05). The patients' kyphosis Cobb angle was significantly improved to 8.71 +/- 5.41 degrees (P < 0.05) , but it was maintained to 9.52 +/- 5. 66 degrees 3 months later, with no significant difference (P > 0.05). The heights of the adjacent discs remained unchanged. No complication was observed during and after operation, and the radiological and the CT scanning evaluations 3 months later showed no failure of the internal fixation. CONCLUSION: The superior and posterior partial resection of the fractured vertebral body followed by the single segmental fusion can effectively decompress the vertebral canal and maintain the spine stability in treatment of the Denis B type fracture though the long-term effectiveness requires a further follow-up.