摘要
目的探讨椎间盘镜下后路椎管减压联合椎体支柱块植入治疗胸腰椎陈旧性骨折的疗效。方法 2006年2月-2009年11月,采用椎间盘镜下后路椎管减压、骨折块复位,联合经椎弓根植入椎体支柱块治疗胸腰椎陈旧性骨折30例。男22例,女8例;年龄17～58岁,平均36.2岁。受伤至手术时间6周～14个月,平均5.3个月。均为单椎体压缩骨折;T91例,T112例,T125例,L111例,L25例,L35例,L41例。术前伤椎Cobb角(27.5±7.5)°,伤椎高度(26.67±5.34)mm,疼痛视觉模拟评分(VAS)为(5.8±1.4)分;椎管狭窄按Wolter分级法:1级17例,2级10例,3级3例;Frankel分级:A级3例,B级8例,C级13例,D级6例。结果手术时间40～120 min,平均70 min;术中出血量100～400 mL,平均180 mL。除1例出现切口皮下血肿外,其余患者切口均Ⅰ期愈合,无下肢深静脉血栓形成等并发症发生。30例均获随访,随访时间24～46个月,平均26个月。术后3 d及末次随访时Cobb角和伤椎高度均较术前显著改善(P<0.01)。末次随访时椎管狭窄按Wolter分级法:0级27例,1级3例;术后24个月脊髓神经功能均有明显恢复,Frankel分级:A级1例,B级1例,C级3例,D级9例,E级16例;与术前比较差异均有统计学意义(P<0.05)。术后1个月VAS评分显著高于术前(P<0.01),随时间延长评分呈下降趋势,术后24个月时显著低于术前(P<0.01)。结论椎间盘镜下后路椎管减压联合椎体支柱块植入治疗胸腰椎陈旧性骨折,具有手术时间短、出血少、椎体复位满意等优点,但对椎间盘镜下操作技术要求较高。
Objective To investigate the effectiveness of spinal canal decompression with microendoscopic disectomy （MED） and pillar vertebral space insertion through pedicle of vertebral arch for thoracolumbar neglected fracture. Methods Between February 2006 and November 2009, 30 patients with thoracolumbar neglected fracture were treated by spinal canal decompression with MED and pillar vertebral space insertion through pedide of vertebral arch. There were 22 males and 8 females with an average age of 36.2 years （range, 17-58 years）. The disease duration was 6 weeks to 14 months with an average of 5.3 months. All patients had single vertebral compression fracture, including T9 in 1 case, Tll in 2 cases, T12 in 5 cases, L, in 11 cases, L2 in 5 cases, L3 in 5 cases, and L4 in 1 case. The preoperative Cobb angle was （27.5 ＋ 7.5）~. The preoperative height of vertebrae was （26.67 ＋ 5.34） mm. The visual analogue score （VAS） was 5.8 ＋ 1.4. According to Wolter classification for spinal canal stenosis, there were 17 cases of grade 1, 10 cases of grade 2, and 3 cases of grade 3. According to Frankel grade, 3 cases were in grade A, 8 cases in grade B, 13 cases in grade C, and 6 cases in grade D. Results The average operation time was 70 minutes （range, 40-120 minutes） and the average blood loss was 180 mL （range, 100-400 mL）. The hematoma occurred in 1 case, and other incisions healed by first intension. No deep vein thrombosis of the lower extremity occurred. All patients were followed up 26 months on average （range, 24-46 months）. The Cobb angle and vertebral height at 3 days and last follow-up were significantly improved when compared with ones before operation （P 〈 0.01）. At last follow- up, the spinal canal stenosis was grade 0 in 27 cases and grade 1 in 3 cases according to Wolter classification. At 24 months after operation, the spinal function was obviously improved; 1 case was in grade A, 1 case in grade B, 3 cases in grade C, 9 cases in grade D, and 16 cases in grade E according to Frankle grade, showing significant differences when compared with preoperative ones （P 〈 0.05）. The VAS score at 1 month after operation was significantly higher than that before operation （P 〈 0.01）, then the score showed downtrend along with time, and it was significantly lower at 24 months after operation than before operation （P 〈 0.01）. Conclusion Spinal canal decompression with MED and pillar vertebral space insertion for thoracolumbar neglected fracture has short surgical time, less blood loss, and satisfactory reduction, but higher technical requirement is necessary for MED.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2012年第12期1420-1424,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胸腰椎陈旧性骨折
椎间盘镜
椎管减压
椎体支柱块
Thoracolumbar neglected fracture Microendoscope Spinal canal decompression Pillarvertebral space
