前路减压重建治疗前中柱损伤的胸腰椎爆裂骨折  

Anterior decompression and reconstruction for the treatment of burst thoracolumbar fractures with anterior and median column injury

作　　者：赵刘军[1] 柴波[1] 徐荣明[1] 马维虎[1] 阮永平[1] 应启迩[1] 曹进[1] 

机构地区：[1]宁波市第六医院脊柱外科,浙江宁波315040

出　　处：《中国骨伤》2008年第1期10-12,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨前路减压重建治疗前中柱损伤的胸腰椎爆裂骨折,评估该方法的术中术后情况。方法:2001年5月至2006年10月运用前路减压重建治疗前中柱损伤的胸腰椎爆裂骨折34例,男22例,女12例;年龄20～63岁,平均40.5岁。损伤节段:T101例,T112例,T129例,L113例,L27例(1例伴有L1轻度压缩骨折),L32例。神经功能按Frankel分级:A级1例,B级9例,C级12例,D级11例,E级1例。术前Cobb角21°～44°,平均27.0°±6.5°。统计手术时间、出血量,并随访术后功能恢复情况。结果:34例患者均获得随访,平均随访24.5个月(3～60个月)。手术时间平均(178±65)min,术中出血量(1750±950)ml,自体血回输量(950±750)ml。术后1例患者出现左侧血气胸,行胸腔闭式引流后愈合。1例术后出现乳糜漏,经引流换药后痊愈。1例患者主诉取髂骨区轻微疼痛。术后椎体高度恢复满意,矢状面畸形矫正,Cobb角矫正至3.0°±1.5°。随访中无明显的后凸角和高度丢失。无内固定松动移位。骨折全部获得融合,无假关节形成。结论:运用前路减压重建治疗前中柱损伤的胸腰椎爆裂骨折,能够Ⅰ期直视下完成减压重建,矫正矢状面畸形,疗效确切。术中运用自体血回输可以减少输血量,有效地保障手术顺利完成。Objective ：To explore the treatment of anterior decompression and reconstruction for burst thoracolumbar fractures with anterior and median column injury and to evaluate the therapeutic effect. Methods：Thirty-four patients suffering from burst thoracolumbar fractures with anterior and median column injury （male 22 and female 12, aged from 20 to 63, with an average of 40.5 years） were treated by anterior decompression and reconstruction from May 2001 to October 2006, Operative duration, bleeding and the neurological function of patients were recorded. Results：All the patients were followed up from 3 to 60 months and the average time was 24.5 months. Operative duration was （ 178±65 ） min. The volume of bleeding was （ 1 750±950） ml and the volume of autotransfusion was （950±750）ml. Cobb angle were corrected from 27.0°±6.5°to 3.0°±1.5°. All fractures obtained fusion. No failure of internal fixation and formation of false joint happened. Conclusion：The technique of anterior decompression and reconstruction for burst thoracolumbar fractures with anterior and median column injury is effective ,with which the decompression and reconstruction of the spinal stability can be performed under direct vision at one stage, and the sagittal alignment can be corrected at the same time. The procedure will be more smoothly by the application of the intraoperative autotransfusion.

关 键 词：胸腰椎 骨折 减压 内固定 

分 类 号：R683.2[医药卫生—骨科学] R581.1[医药卫生—外科学]