前路手术治疗胸腰椎爆裂性骨折  

Anterior surgery for thoracic and lumbar burst fractures

作　　者：张之栋[1] 杨怀远[1] 徐洪森[1] 刘艺明[1] 周业金[1] 苏家庆[1] 

机构地区：[1]合肥市第一人民医院骨科,安徽合肥230061

出　　处：《临床骨科杂志》2006年第2期143-145,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨前路手术治疗胸腰椎爆裂性骨折的手术时机、临床疗效和主要并发症。方法经前路椎管减压、复位矫形、自体髂骨植骨Z-p late内固定治疗胸腺椎爆裂性骨折20例。伤后4~72 h手术12例、10 d^6个月手术8例。结果1例手术中死亡。19例获3~18个月的随访,平均10个月。Frankel分级:A级1例无恢复;B级恢复到C级2例,恢复到D级1例;C级恢复到D级5例,恢复到E级2例;D级恢复到E级9例。术后摄片示椎管减压充分,后凸畸形完全纠正。3个月后植骨融合,Cobb角丢失6°~9°,平均7.3°。主要并发症为大出血、肋间神经痛、股外侧皮神经损伤。结论前路入路治疗胸腰椎爆裂性骨折临床疗效良好,新鲜的胸腰椎爆裂性骨折限期手术失血少。Objective To investigate the timing of operation, clinical outcomes and main complication of anterior surety for thoracic and lumbar burst fractures. Methods 20 cases with thoracic and lumbar burst fractures were operated on by anterior decompression, correction, reduction ,iliac autograft, Z-plate internal fixation. 12 patients were operated on 4 to 72 hours after admission,while 8 patients were operated on 10 days to 6 months after admission. Results 1 patient died during operation because of excessive blood loss, the others were followed up for 3 - 18 months（ average 10 months）. Neurological status improved at Frankel grade from B to C in 2 patients, from B to D in 1 patient, from C to D in 5 patients, from C to E in 2 patients, from D to E in 9 patients. 1 patient marked Frankel A remained unchanged. Complete decompression of spinal canal and correction of kyphosis were testified postoperatively by CT and roentgenograms. The fusion was observed between autograft and vertebrae and the correction loss of Cobb＇s angle averaged 7.3°（ranging from 6° to 9°） at 3 months after surgery. The main complications were excessive blood loss, intercostal nerve pain, and lateral femoral cutaneous nerve impairment. Conclusions Clinical outcomes of anterior surgery for thoracic and lumbar burst fractures are satisfied and the intraoperative blood loss is less when surgery starts at limited interval after admission.

关 键 词：胸椎 腰椎 脊柱骨折/外科学 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]