摘要
[目的]探讨后路椎板开窗减压加对侧椎板植骨融合治疗胸腰椎爆裂性骨折伴不全瘫的临床疗效。[方法]回顾分析本院从2007年2月～2011年2月收治的48例胸腰椎骨折伴不全瘫的患者,均行后路椎板开窗减压加对侧椎板植骨融合治疗,观察患者疗效。并选择同期分级相似胸腰椎骨折伴不全瘫的患者51例行椎板切除减压作为对照组,将两者出血量、手术时间及术后疗效做一对比。[结果]椎板开窗组术后未出现神经损伤加重及死亡病例。脊柱后凸角度(Cobb角)、伤椎椎体前缘高度、椎管占有率与术前相比,具有统计学意义;患者脊髓及神经损伤ASIA分级术后部分有明显改善;术后1年患者影像学资料显示骨折骨性愈合。无内固定物松动及断裂发生。与椎板切除组相比,椎板开窗组手术时间及手术出血量(术中+术后引流)具有统计学意义。[结论]与后路椎板切除组相比,后路椎板开窗减压加对侧椎板植骨融合治疗胸腰椎爆裂性骨折伴不全瘫具有创伤小、出血少,操作简单、手术时间相对较短,能较大限度保持后结构完整等优势,术中脊髓也能得到有效减压,术后疗效可靠。
[ Objective ] To explore the therapeutic effect of neurological function recovery with surgical treatment on thorac- ic and lumbar vertebrae burst fracture with incomplete neurological deficit by posterior laminotomy decompression and bone graft in lamina of vertebra. [ Method ] The clinical data of 48 cases of the thoracic and lumbar vertebrae burst fracture with incomplete neurological deficit in our department from Feb 2007 to Feb 2011 were analyzed retrospectively. All of the patients were treated by posterior fixation with posterior laminotomy decompression and bone graft in lamina of vertebra. The patients outcomes were observed and 51 cases with similar classification were selected as the control group, the difference was compared with the amount of bleeding, operation time and postoperative results. [ Result] No severe complication was found in all patients during and after surgery. In the laminotomy group, there was a significant difference between the two groups on the kyphotic angle, the anterior vertebral body height and the rate of canal compromise. According to ASIA grading, part of the cases were improved. It was shown that the fracture were healing without internal fixation loosening and fracturing after 1 year. Compared with the laminecto- my group, there was significant difference on the operative time and blood lossing. [ Conclusion ] The operation of posterior lami- notomy decompression and bone graft in lamina of vertebra can stabilize the thoracic and lumbar vertebrae burst fracture, im- prove the neurological function. Compared with the laminectomy group, it has advantages of less bleeding, simple, short time and so on and can largely retain the posterior spinal construction.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2012年第22期2039-2042,共4页
Orthopedic Journal of China
关键词
胸腰椎骨折
椎板开窗
植骨融合
thoracic and lumbar vertebrae fracture
laminotomy decompression
bone fusion
