摘要
目的探讨后路脊柱前中柱次全切三柱重建术治疗严重胸腰椎爆裂骨折的临床价值。方法对36例严重胸腰椎爆裂骨折行此手术。采用ASIA分级对神经功能评估。比较术前、术后及末次随访时伤椎前缘压缩率、脊柱局部Cobb角、椎管矢状径侵占率,评估复位、减压及融合情况。结果术后血气胸、脑脊液漏各1例,均治愈。平均随访17.8个月,无其他并发症。神经功能除A级外均有1～2级的恢复。伤椎前缘压缩率、脊柱局部Cobb角、椎管矢状径侵占率术后及末次随访时较术前有统计学差异(P<0.05),末次随访时较术后无明显变化(P>0.05)。结论该手术创伤小、并发症少、减压彻底,能有效重建脊柱三柱结构,防止复位丢失及内固定失败,是治疗严重胸腰椎爆裂骨折的理想手术方式。
Objective To explore the clinical value of subtotal corpectomy of spinal anterior median vertebral column and three column reconstruction through posterior approach in treatment of severe thoracolumbar bursting fracture. Methods Totally 36 patients with severe thoracolumbar bursting fracture were treated with the technique of subtotal corpectomy of anterior median spinal vertebral column and three column reconstruction through posterior approach. Spinal cord injuries were evaluated with ASIA grade criterion. Reduction, decompression and fusion of fractures were assessed by evaluation of the anterior vertebral compression rado, Cobb angle for local kypbesis and sagittal diameter of injured vertebral spinal canal encroachment ratio before and after operation and at the time of last follow-up. Results Hemopneumothorax and cerebrospinal fluid leakage respectively occurred in one patient and were treated successfully. The average follow-up duration was 17.8 months. Nervous function improved in different degree in all patients except those patients who had the nervous function of grade A. The anterior vertebral compression ratio, Cobb angle for local kyphosis and sagittal diameter of injured vertebral spinal canal encroachment ratio after operation and at the time of last follow-up were more significant than before operation （P 〈0.05）. There was no significant difference between those after operation and at the time of last follow-up （P 〉 0.05）. Conclusion The operation has the advantages of less injury, fewer complications, thorough spinal cord decompression, effectively recovering the stability of the three--column spine, avoiding loss of resetting and rupture of internal fixation. It is an ideal operation method for the treatment of thoracolumbar bursting fracture.
出处
《中国骨与关节损伤杂志》
2012年第9期795-797,共3页
Chinese Journal of Bone and Joint Injury
关键词
后路
次全切
三柱重建
胸腰椎爆裂骨折
Through posterior approach
Corpectomy
Three column reconstruction
Thoracolumbar bursting fracture
