摘要
背景:目前腰椎爆裂性骨折的外科治疗方式主要包括脊柱前路、脊柱后路和脊柱前后联合入路内固定处理。然而何种处理方式最佳,它们的适应证如何,目前还存在争议。目的:评价脊柱前路内固定器系统内固定及脊柱后路椎弓根钉棒系统内固定和前2种方法联合治疗腰椎爆裂性骨折的临床疗效。方法:腰椎爆裂性骨折79例。根据患者情况,分别采用脊柱后路椎弓根钉棒系统内固定治疗57例;脊柱前路内固定器系统内固定治疗12例;脊柱前路内固定器系统内固定加脊柱后路椎弓根钉棒系统内固定联合治疗10例。采用ASIA标准评定治疗前后神经功能恢复情况;观察治疗前后伤椎Cobb角以及矫正度丢失、骨性融合率、内固定失效率及治疗过程的操作时间和出血量。结果与结论:79例随访>19个月。除5例完全性截瘫患者神经功能无恢复,其余63例不全瘫患者治疗后神经功能(ASIA分级)均恢复1级或1级以上。3种入路置入植入物内固定治疗后患者伤椎Cobb角以及神经功能的恢复均较治疗前明显改善(P<0.05);脊柱后路椎弓根钉棒系统内固定治疗患者腰椎矫正度丢失明显高于脊柱前路内固定器系统内固定或脊柱前后联合入路治疗(P<0.05)。脊柱后路内固定器系统内固定患者操作时间、出血量较脊柱前路内固定器系统内固定或脊柱前后联合入路治疗明显减少(P<0.05)。脊柱后路椎弓根钉棒系统内固定有5例患者发生内固定断裂。3种入路置入植入物内固定治疗在骨性融合率和神经功能恢复方面差异无显著性意义(P>0.05)。结果表明,3种入路置入植入物内固定均能有效治疗腰椎爆裂性骨折,临床疗效满意;后路椎弓根钉棒系统内固定治疗易出现内固定断裂和治疗后矫正度丢失;脊柱前路内固定器系统内固定和脊柱前路内固定器系统内固定加脊柱后路椎弓根钉棒系统内固定联合治疗后矫正度丢失较少。因此应个体化选择治疗入路,以期获得最佳的临床疗效。
BACKGROUND：Currently, the treatment methods of lumbar burst fractures include anterior spinal approach, posterior spinal approach, and anterior combined with posterior approach. However, it is stil controversial which the best approach is for lumbar burst fracture and what are their indications. OBJECTIVE：To assess clinical outcomes of surgical treatments through anterior, posterior approaches, and anterior combined with posterior approach for lumbar vertebrae burst fractures. METHODS： A total of 79 patients with lumbar burst fractures were treated by operation. Different approaches were selected according to conditions of injury： posterior approach （57 patients）, anterior approach （12 patients）, and anterior combined with posterior approach （10 patients）. ASIA was used to assess the recovery of neurological function before and after treatment. Cobb angle, correction loss of Cobb angle, bone fusion rate, failure rate of internal fixation, operative time and intraoperative bleeding loss were observed before and after treatment. RESULTS AND CONCLUSION：Al 79 patients were folowed up for at least 19 months. Except no changes in the 5 complete paralysis cases, the ASIA classification of postoperative nerve function in 63 incomplete paralysis＆nbsp;cases was improved by 1 grade or more. ASIA grade and the Cobb angle were obviously improved after operation, showing significant differences between preoperation and last folow-up （P 0.05）. Results suggested that the three surgical approaches can effectively treat lumbar burst fractures, and can achieve satisfactory clinical outcomes. Posterior approach easily affected fixation breakage and postoperative correlation loss. Anterior approach and anterior combined with posterior approach obtained less correlation loss. The surgeons should choose the surgical approach according to the characteristics of patients, and aim to achieve the best clinical outcomes.
出处
《中国组织工程研究》
CAS
CSCD
2014年第22期3498-3503,共6页
Chinese Journal of Tissue Engineering Research
