摘要
目的探讨一期后路矫治胸椎及胸腰段脊椎新鲜或陈旧性骨折脱位的疗效。方法对45例胸椎及胸腰段脊椎骨折伴前后、侧方脱位畸形及脊髓损伤患者均一期行后路手术,32例新鲜骨折患者行椎管减压、经伤椎及其相邻上下椎椎弓根置6钉(或5钉)2棒复位固定植骨融合术;13例陈旧骨折患者行全脊椎切除、环脊髓减压、复位、人工椎体或钛网复合自体碎骨粒置入并内固定重建术。术后观察脊髓神经功能恢复情况;X线摄片复查。结果 45例均获随访,时间1～5年。末次随访时Frankel分级:A级28例均无恢复,B级9例恢复至C级2例、D级4例、E级3例,C级8例恢复至D级2例、E级6例。影像学检查显示矢状面、冠状面前后及侧方移位程度均明显改善。患者在术后6个月内均获得骨性融合。结论对于新鲜或陈旧性胸椎及胸腰段脊椎骨折脱位,均可行后路减压,骨折脱位畸形矫形效果满意。
Objective To discuss the effect of single-stage operation for the fracture-dislocations of thoracic and thoracolumbar vertebrae through posterior approach.Methods 45 cases of the fracture-dislocations of thoracic and thoracolumbar vertebrae with spinal cord injury were operated through posterior approach: the 32 fresh fracture-dislocations patients were treated by neural decompression,deformity correction,strut bone grafting,inserting 6 or 5 pedicle-screws in both fractured vertebrae and its adjacent upper and lower vertebrae;the 13 old patients were done by posterior vertebral column resection,circum spinal cord decompression,and bony strut bone grafting,implant adjustable hollow titanium artificial vertebral body or titanium cage and transpedicular internal fixation.After operation the neurologic status,deformity correction,and bony fusion were evaluated.Results All the patients were followed up for 1 to 5 years.At last follow up the neurological status of all the patients according to Frankel grade as follow: none of 28 cases of grade A was improved;9 cases at grade B were improved to grade C in 2,D in 4 and E in 3;8 cases at grade C were improved to grade D in 2 and E in 6.All patients the deformity was corrected in the sagittal plane and in the coronal plane according to X-rays.Bony fusion was obtained in all patients within 6 months.Conclusions It is a better selection with decompression,correcting deformities through posterior approach for the old or fresh fracture-dislocations of thoracic and thoracolumbar vertebrae.
出处
《临床骨科杂志》
2011年第6期609-612,共4页
Journal of Clinical Orthopaedics
关键词
胸腰椎
脊柱骨折脱位
后路
骨折固定术
内
thoracolumbar vertebrae
spinal fracture-dislocation
posterior approach
fracture fixation,internal
