前路减压融合结合前路或后路固定治疗严重的胸腰椎爆裂性骨折  

Anterior decompression and stabilization with anterior or posterior instrumentation for treatment of the serious thoracolumbar burst fractures

作　　者：元虎[1] 郑光彬[1] 陈继良[1] 黄雄延[1] 金明[1] 

机构地区：[1]延边大学附属医院骨科,吉林省延吉133000

出　　处：《中国矫形外科杂志》2007年第14期1041-1044,共4页Orthopedic Journal of China

摘　　要：[目的]评价经前路减压融合结合前路或后路固定治疗严重的胸腰椎爆裂性骨折的临床疗效,探讨在不同条件下其适应证的选择。[方法]采用爆裂性骨折的Den is分类,对28例严重的胸腰椎爆裂性骨折患者实施经前路减压融合结合前路或后路固定进行治疗。28例患者中单一节段椎体骨折为25例,2个相邻段椎体骨折为2例,隔1个椎体发生2个节段椎体骨折为1例,椎体的破坏程度采用M cCorm ack的LSC评分。[结果]26例获得随访,病人术后疼痛均明显缓解(VAS评分改善),椎体高度和形态得到明显恢复(Cobb′s角平均改善14.5°)。经术后平均21.5个月随访,疼痛均消失,椎体间支撑植骨愈合好,无Cobb′s角加大,未发现明显并发症。[结论]经前路减压融合结合前路或后路固定术能即时增加脊柱前柱的抗压稳定性,减压充分,在椎体间支撑植骨的同时结合各种内固定,使患者早期活动,是治疗严重胸腰椎爆裂性骨折的有效方法。[ Objective ] To evaluate the clinical effect for the treatment of severe thoracolumbar vertebral burst fracture by the method of anterior vertebral decompression and fusion combining anterior or posterior fixation, and investigate its indications in different conditions. [ Method] At the standard of Denis, twenty-eight cases were treated by anterior vertebral decompression and fusion combining anterior or posterior fixation. In a total of 28 cases ,25cases were single vertebral fractures ,2 cases were two adja- cent vertebral fractures and 1 case was two vertebral fractures comparted by one unfractured centrum, the level of vertebral de- struction was ruled by LSC scale of McCormack. [ Result]26 cases were reviewed, all patients＇pain were relieved obviously after the operation, （ VAS scale improved） , the height and shape of the fractured centrums recovered obviously（ Cobbg angle improved 14.5° in average）. After an average of 21.5 months follow-up, the pain all disappeared, the intervertebral grafted bone reached bony union, no Cobbg angle increased and no apparent implication occurred in all cases. [ Conclusion] Application of anterior vertebral decompression and fusion combining anterior or posterior fixation can increase the stability of the anterior column of the spine, decompress completely, the intervertebral bone graft with kinds of interbody fixation enables the patients to move as early as possible, it is an effective method in treatment of severe thoracolumbar vertebral burst fracture.

关 键 词：胸腰椎爆裂性骨折 前路融合 固定 

分 类 号：R687.3[医药卫生—骨科学]