前路手术治疗胸腰段爆裂型骨折伴不全性神经损伤——附19例报告

目的探讨对胸、腰椎爆裂型骨折伴不全性神经损伤患者行前路手术治疗的疗效。方法对19例不稳定性胸、腰椎爆裂型骨折伴不全性神经损伤患者行侧前方椎管减压、自体骨植骨融合、Kaneda器械内固定治疗。结果全部患者经1~6年随访,脊椎后凸畸形由术前平均25.1°提高到术后平均13°,平均椎管占位率由术前45%提高到最终随访的10%。神经功能按ASIA分级示,提高1级者有12例,2级者有4例;14例膀胱/直肠障碍者有5例完全恢复,8例有不同程度的改善,1例无变化。结论胸、腰椎爆裂型骨折伴不全性神经损伤患者经侧前路减压融合、Kane-da内固定器可较好地提供脊柱的即刻稳定性、矫正后凸畸形、有利于早期下床行走和防止继发性脊髓或马尾神经损伤。大多数不全性神经损伤的患者,其神经功能至少可提高1级,而脊髓圆锥创伤的患者可表现为部分直肠和膀胱功能的恢复。

Surgical treatment of thoracolumbar burst fractures with incomplete neurological deficit by anterior approach in 19 patients

Objective To explore the therapeutic effect of surgical treatment on thoracolumbar burst fractures with incomplete neurological deficit by anterior approach. MethodsNineteen patients of instable thoracolumbar burst fractures with incomplete neurological deficit were treated with anterolateral decompression, bone graft and fusion with autogenous bone and internal fixation with Kaneda system. ResultsAll the patients were followed up for 1-6 years. The mean kyphotic angle was improved from 25.1 degrees preoperatively to 13 degrees postoperatively, and the mean rate of canal compromise was improved from 45% preoperatively to 10% at the final follow-up. According to ASIA grading, there were 12 patients improved by one grade and 4 patients by two grades. In 14 patients with neurogenic rectum or bladder disorder, 5 recovered completely,8 had improvement in different degrees and 1 had no change. ConclusionThe surgical procedure of anterolateral decompression, bone graft and fusion and internal fixation with Kaneda system for thoracolumbar burst fractures with incomplete neurological deficit can obtain instant stability, correction of deformity, early ambulation and protection against further cord or cauda equina injury. Neurological function can be improved by at least one grade in the patients with incomplete neurological deficit, and with conus medullaris injury rectum and bladder function can get partial recovery.