胸腰段脊柱骨折的手术适应证和术式选择

目的探讨胸腰段脊柱骨折手术适应证和术式选择。方法总结2001~2004年71例胸腰段脊柱骨折临床资料,27例椎管占位大于50%,采用前路减压钛网植骨内固定术;44例椎管占位不超过50%,采用后路椎弓根螺钉内固定后外侧植骨融合术。结果前路手术组所有病例均达到骨性愈合,钛网钢板无移位及断裂,椎体高度无丢失。后路手术组椎体压缩畸形及椎体高度均有恢复,但椎弓根螺钉断裂2例,松动1例。结论前路手术减压彻底,植骨融合率高,但操作复杂,创伤大;后路手术简单,操作容易,对椎管占位小于50%者也能起到间接减压作用。应严格掌握手术指征,选择不同术式,做到既能达到治疗效果,又能尽量减少手术创伤。

Evaluation of Different Surgical Procedures for Treatment of Thoracolumbar Spine Fractures

Objective To evaluate the surgical indications and the different surgical procedures for the treatment of the thoracolumbar spine fractures.Methods Through the clinical analysis of 71 patients with the thoracolumbar spine fractures,twenty-seven patients with spinal canal stenosis more than 50% were treated with the anterior approach. Forty-four patients with the spinal canal stenosis less than 50% were treated with the posterior approach.Results In the anterior approach group, the postoperative CT result showed the volumes of the spinal canals were enlarged evidently. In the posterior approach group, the postoperative X-ray films showed the recovering result of vertebra height were satisfactory. There were no severe postoperative complications such as deterioration of nerve function in two groups.Conclusion The anterior and posterior approaches have different advantages and characteristics. For the surgical treatment of the thoracolumbar spine fractures, the key is to evaluate the surgical indications and select the different surgical approaches according to different clinical patients.