| 后路经椎管减压并脊椎三柱重建技术治疗合并神经损伤的胸腰椎爆裂性骨折 |
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投稿时间：2017-05-16
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| 作者 | Author | 单位 | Address | E-Mail |
| 吴李勇 |
WU Li-yong |
福建医科大学附属闽东医院脊柱外科八区, 福建 闽东 355000 |
The Eighth Department of Spinal Surgery, Fujian Mindong Hospital Affiliated to Fujian Medical University, Mindong 355000, Fujian, China |
wuliyong@medmail.com.cn |
| 黄雪梅 |
HUANG Xue-mei |
福建医科大学附属闽东医院脊柱外科八区, 福建 闽东 355000 |
The Eighth Department of Spinal Surgery, Fujian Mindong Hospital Affiliated to Fujian Medical University, Mindong 355000, Fujian, China |
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| 王越 |
WANG Yue |
福建医科大学附属闽东医院脊柱外科八区, 福建 闽东 355000 |
The Eighth Department of Spinal Surgery, Fujian Mindong Hospital Affiliated to Fujian Medical University, Mindong 355000, Fujian, China |
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| 杨朝勃 |
YANG Zhao-bo |
福建医科大学附属闽东医院脊柱外科八区, 福建 闽东 355000 |
The Eighth Department of Spinal Surgery, Fujian Mindong Hospital Affiliated to Fujian Medical University, Mindong 355000, Fujian, China |
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| 苏盛辉 |
SU Sheng-hui |
福建医科大学附属闽东医院脊柱外科八区, 福建 闽东 355000 |
The Eighth Department of Spinal Surgery, Fujian Mindong Hospital Affiliated to Fujian Medical University, Mindong 355000, Fujian, China |
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| 王春 |
WANG Chun |
福建医科大学附属闽东医院脊柱外科八区, 福建 闽东 355000 |
The Eighth Department of Spinal Surgery, Fujian Mindong Hospital Affiliated to Fujian Medical University, Mindong 355000, Fujian, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第4期，第322-327页 |
| DOI：10.3969/j.issn.1003-0034.2018.04.006 |
| 基金项目: |
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中文摘要:
目的：探讨后正中入路椎板切除后经椎管进行椎体前中柱减压重建联合椎弓根螺钉内固定技术治疗合并有神经损伤症状胸腰椎爆裂性骨折的可行性及临床疗效。
方法：回顾性分析自2011年3月至2016年4月收治的36例符合纳入标准的胸腰椎爆裂性骨折患者，男20例，女16例；年龄21~52岁，平均37.6岁；均为单一节段骨折，T11 8例，T12 10例，L1 12例，L2 6例。按胸腰椎脊柱脊髓损伤严重度评分系统（thoracolumbar injury classification and severity score，TLICS）总评分为7~9分，平均7.4分。按美国脊柱损伤学会（America Spine Injury Association，ASIA）的神经病损分级，A级4例，B级10例，C级14例，D级8例。36例均采用正中入路椎板切除后经椎管进行椎体前中柱减压重建联合椎弓根螺钉内固定技术治疗。分别对比评估术前、术后初期、末次随访时以下各项指标：神经功能的恢复情况（ASIA分级评估）；后凸畸形矫正（Cobb角）情况；伤椎椎管容积变化情况；伤椎前缘高度变化情况；记录内固定松动、断裂情况及植骨面融合情况。
结果：手术均顺利完成，手术时间2.1~3.5（2.8±0.3）h；术中出血量为550~1 350（880±120）ml；切口均Ⅰ期愈合。术后均获随访，时间12~28个月，平均18.4个月。全部获得骨性愈合，无假关节形成及内固定松脱、移位、断裂等情况发生。术后神经功能情况：除A级和B级各有1例无明显恢复外，其余患者均有不同程度的恢复，术后ASIA分级为：A级1例，B级1例，C级7例，D级10例，E级17例。术后3 d伤椎前缘高度、后凸畸形、伤椎椎管容积恢复均较术前明显改善（P<0.05）；且各个指标在末次随访（术后12个月）结果与术后初期复查无明显改变（P>0.05）。
结论：后正中入路椎板切除后经椎管进行椎体前中柱减压重建联合椎弓根螺钉内固定技术治疗合并有神经损伤症状胸腰椎爆裂性骨折，可以经单一入路同时完成骨折复位、环脊髓360°减压和脊椎的三柱重建；其椎管减压彻底、即刻稳定脊柱、能达到前后联合入路所能取得的手术效果，是一种安全有效、值得推广的手术方式。 |
| 【关键词】胸腰椎爆裂性骨折 神经损伤 三柱重建 后路手术 |
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| Posterior spinal canal decompression with screw fixation and reconstruction of three vertebral column for thoracolumbar burst fractures complicated with nerve injury |
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ABSTRACT
Objective: To explore the feasibility and clinical effect of posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column for thoracolumbar burst fractures complicated with nerve injury.
Methods: A total of 36 patients with thoracolumbar burst fractures treated from March 2011 to April 2016 were enrolled in the retrospective study. There were 20 males and 16 females,aged from 21 to 52 years old with an average of 37.6 years. All the fractures were located on a single segment,8 cases of T11,10 cases of T12,12 cases of L1,6 cases of L2. According to thoracolumbar injury classification and severity score(TLICS) system,the score was 7 to 9 points,with an average of 7.4 points. According to the America Spine Injury Association(ASIA) grade,4 cases were type A,10 cases were type B,14 cases were type C,8 cases were type D. All the patients underwent posterior spinal canal decompression with pedicle screw fixation and reconstruction of anterior and middle vertebral column. The recovery of nerve function was evaluated by ASIA grading. The correction of kyphosis(Cobb angle),the volume change of injuried spinal canal,the change of anterior border height of injury vertebra which can be observed by X-rays;the internal fixation loosening and breakage and all the information of bone fusion were recorded.
Results: All the operations were successful,the mean operative time and intraoperative blood loss were(2.8±0.3) h (2.1 to 3.5 h) and (880±120) ml(550 to 1 350 ml),respectively. All the incisions got primary healing. All the patients were followed up for 12 to 28 months with an average of 18.4 months. All the patients obtained satisfactory bone fusion. No pseudoarticulation formation was found,and there was no loosening,breakage of pedicle screws or displacement of titanium mesh. Neurological function was improved in different degree,except in one patient with grade A and another one with grade B. According to the ASIA grade,there were 1 case of type A,1 case of type B,7 cases of type C,10 cases of type D and 17 cases of type E,postoperatively. At 3 days after operative,the anterior border height of injury vertebra,Cobb angle and the volume changes of injury spinal canal were obviously improved(P<0.05),and there was no significant difference between postoperative at 3 days and final follow-up(P>0.05).
Conclusion: Spinal canal decompression with screw fixation and reconstruction of anterior and middle vertebral column through posterior midline approach is a safe and effective method in the treatment of thoracolumbar burst fractures with nerve injury,it is worthy to be popularized. It can complete the spinal canal decompression of 360 degree,reduction of fractures and reconstruction of vertebral three-column at the same time through a single posterior approach. The advantages includes less trauma,perfect decompression,good stability and etc. |
| KEY WORDS Thoracolumbar burst fractures Nerve injury Reconstruction of three-column Posterior approach |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 吴李勇,黄雪梅,王越,杨朝勃,苏盛辉,王春.后路经椎管减压并脊椎三柱重建技术治疗合并神经损伤的胸腰椎爆裂性骨折[J].中国骨伤,2018,31(4):322~327 |
| 英文格式: | WU Li-yong,HUANG Xue-mei,WANG Yue,YANG Zhao-bo,SU Sheng-hui,WANG Chun.Posterior spinal canal decompression with screw fixation and reconstruction of three vertebral column for thoracolumbar burst fractures complicated with nerve injury[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(4):322~327 |
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