| 手术治疗胸腰椎爆裂骨折的临床研究 |
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Received:April 13, 2011
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| 期刊信息：《中国骨伤》2011年24卷，第7期，第547-552页 |
| DOI：10.3969/j.issn.1003-0034.2011.07.005 |
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目的：探讨胸腰椎爆裂骨折的手术方式选择和其临床疗效。
方法：2005年9月至2009年3月，手术治疗94例胸腰椎爆裂骨折，男59例，女35例；年龄20～63岁，平均36.8岁。骨折按Denis分型：A型17例，B型32例，C型6例，D型24例，E型15例。神经损伤按ASIA分级：A级3例，B级4例，C级23例，D级38例，E级26例。其中42例选择后路手术复位、减压，椎弓根螺钉内固定，18例同时行后外侧植骨；36例选择前路手术减压、植骨，TSRH钉棒系统内固定16例，Zeplate钢板固定20例；16例因三柱严重损伤骨折块明显突入椎管并且压迫脊髓行Ⅰ期前后联合入路、后路椎弓根螺钉内固定、前路椎体次全切除减压钛网植骨术，8例同时行前路钉棒、钛钢板内固定术。
结果：所有患者均获随访，时间9～52个月，平均22.8个月。前路、后路及前后联合手术均获得较好的疗效，Cobb角由术前的(25.00±5.50)°矫正至术后(4.20±1.80)°，术后椎体前缘、后缘高度分别从术前(50.80±2.82)%恢复至(94.85±1.80)%及(79.30±3.08)%恢复至(98.20±1.40)%,CT显示椎管狭窄率从术前(33.10±1.40)%恢复至(6.70±1.50)%.矢状面的畸形矫正，随访中无明显的后凸角丢失和高度丢失。无内固定松动和钛网移位。除1例ASIA功能评定为A级的患者神经功能无恢复外，其余病例均有不同程度的恢复。术后ASIA分级A级恢复至B级2例，B级恢复至C级2例、D级2例；C级恢复至D级16例、E级7例；D级恢复至E级38例。
结论：只要术前病情判断准确，手术方式选择合理，前路、后路及前后联合手术均可获得较好的疗效。决定胸腰椎骨折手术入路选择最重要的两个因素是椎体后方韧带复合结构的完整性及神经系统功能状态，对有不完全神经功能操作且影像学检查证实压迫来自椎管前方者，通常需要前路减压；对有椎体后方韧带复合结构破坏者，通常需要后路手术；对两种损伤均存在者通常需要前后路联合手术。 |
| [关键词]:胸椎 腰椎 骨折固定术，内 脊柱融合术 骨移植 减压 |
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| Clinical study on surgical treatment for thoracolumbar burst fractures |
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Abstract:
Objective: To explore the choice of operative approach for thoracolumbar burst fractures and evaluate its clinical effects.
Methods: From September 2005 to March 2009,the clinical data of 94 patients with thoracolumbar burst fractures were analyzed retrospectively. Including 59 males and 35 femals with an average age of 36.8 years (ranged from 20 to 63). The fractures were classified according to Denis classification:17 cases of type A,32 cases of type B,6 cases of type C,24 cases of type D,15 cases of type E. Neurological injuries were classified according to ASIA classification:3 cases of grade A,4 cases of type B,23 cases of grade C,38 cases of grade D,26 cases of grade E. Among the patients,42 cases were treated with reduction,decompression,internal fixation with pedicle-screw through posterior approach,meanwhile,of them,18 cases with posterior-lateral bone graft fusion;36 cases were treated with decompression,bone graft,through anterior approach,of them,16 cases with TSRH system fixation and 20 cases with Zeplate system fixation;16 cases(because of bone block intruded into vertebral canal leading to spinal cord compression ) were treated with anterior and posterior approach,internal fixation with pedicle-screw through posterior approach and subtotal vertebrectomy,decompression,titanium mesh cages bone graft fusion through anterior approach,meanwhile,of them,8 cases with screw-rod and titanium steel plate system fixation.
Results: All patients obtained good results and were followed up from 9 to 52 months with an average of 22.8 months. Cobb angle were corrected from preoperatively(25.00±5.50)° to postoperatively(4.20±1.80)°。 Height of anterior and posterior border of vertebral body improved from preoperatively (50.80±2.82)%,(79.30±3.08)% to postoperatively(94.85±1.80)%,(98.20±1.40)%,respectively. The ratio of protruded bones to the spinal canal anteroposterior diameter decreased from preoperatively (33.10±1.40)% to postoperatively(6.70±1.50)%. Sagittal abnormity were corrected;posterior convex angle and height were no markedly lost during follow-up;no internal fixation loosening and titanium mesh displacement were found. In the aspect of never function,except for 1 case of grade A there is no recovered others obtained different improvement,among them,from grade A to B was in 2 cases;B to C,D was in 2,2,respectively;C to D,E was 16,7,respectively;D to E was in 38 cases.
Conclusion: The two factors decide surgical methods:the integrity of posterior ligamentous complex and nervous system function. Anterior approach refers to patients with incomplete spinal cord injury and anterior vertebral canal compression;posterior approach refers to patients with injury of posterior ligamentous complex;combination with anterior and posterior approach refers to patients with two injury factors. |
| KEYWORDS:Thoracic vertebrae Lumbar vertebrae Fracture fixation,internal Spinal fusion Bone transplantation Decompression |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 徐卫星,徐荣明,蒋伟宇,丁伟国,祝卫民,张春,王健,卢笛.手术治疗胸腰椎爆裂骨折的临床研究[J].中国骨伤,2011,24(7):547~552 |
| 英文格式: | XU Wei-xing,XU Rong-ming,JIANG Wei-yu,DING Wei-guo,ZHU Wei-min,ZHANG Chun,WANG Jian,LU Di.Clinical study on surgical treatment for thoracolumbar burst fractures[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(7):547~552 |
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