侧前方减压空心多轴向螺钉内固定治疗胸腰段椎体爆裂性骨折  

Anterolateral decompression and internal fixation with hollow multiaxial screw for thoracolumbar burst fractures

作　　者：林宏生[1] 查振刚[1] 王国普[1] 李志忠[1] 吴昊[1] 刘宁[1] 

机构地区：[1]暨南大学附属第一医院骨科,广州510630

出　　处：《中华创伤杂志》2005年第6期427-430,共4页Chinese Journal of Trauma

摘　　要：目的探讨侧前方减压、植骨、空心多轴向螺钉内固定治疗胸腰段椎体爆裂性骨折的临床价值。方法总结21例经侧前方减压、植骨、空心多轴向螺钉内固定治疗胸腰段椎体爆裂性骨折患者的临床资料,对其后凸畸形的矫正、伤椎压缩程度的恢复、脊髓神经功能的康复及手术并发症进行分析。结果21例术后平均随访时间13个月。随访期内,植骨块和固定器位置良好,骨愈合时间平均为4.3个月。术前脊柱后凸畸形Cobb角为(24.6±8.7)°,术后为(5.4±4.3)°。术前受伤椎体压缩程度为(43.5±16.6)%,术后为(7.4±6.2)%。16例伴不完全性截瘫患者脊髓神经功能恢复良好,按Frankel分级达到D级或E级。手术并发症:脑脊液漏1例,术侧腹股沟周围皮肤麻木3例。结论侧前方减压、植骨、空心多轴向螺钉内固定治疗胸腰段椎体爆裂性骨折具有椎管减压彻底、内固定可靠、植骨融合率高等优点,重建了脊柱的稳定性,有利于脊髓神经功能的恢复。Objective To discus clinical value of anterolateral decompression, bone grafting and internal fixation with hollow multiaxial screw for thoracolumbar burst fractures. Methods The clinical data of 21 cases with thoracolumbar burst fractures treated with anterolateral decompression, bone grafting and hollow multiaxial screw fixation were retrospectively studied for analysis of kyphosis correction, compression vertebra restoration, neurological recovery and complication. Results All cases were followed up for average 13 months. The average period of bone union was 4.3 months, with good location of both bone grafting and internal fixation device. The average kyphosis angle was (24.6±8.7)° preoperatively and (5.4±4.30) ° postoperatively. The average compression of fractured vertebral body was (43.5±16.6)% preoperatively and (7.4±6.2)% postoperatively. Sixteen patients with incomplete paraplegia got sound nervous function restore, with nervous function up to Grades D or E of Frankels grading. Disruption of the dura mater of the spinal cord occurred in one case and numb skin around the groin in operative side appeared in three cases. Conclusions Anterolateral decompression, bone grafting and internal fixation with hollow multiaxial screw for thoracolumbar burst fractures can achieve adequate decompression, reliable fixation, high fusion rate and reconstruction of spine stability and is beneficial to improvement of spinal nerve function.

关 键 词：螺钉内固定治疗 椎体爆裂性骨折 侧前方减压 轴向 脊髓神经功能恢复 FRANKEL 手术并发症 脊柱后凸畸形 胸腰段椎体 Cobb角 植骨融合率 临床价值 临床资料 骨折患者 随访时间 愈合时间 椎体压缩 截瘫患者 不完全性 脑脊液漏 

分 类 号：R687.3[医药卫生—骨科学]