后路三柱固定治疗胸腰段椎体爆裂骨折  

Three Column Stabilization through Posterior Approach for the Treatment of Unstable Thoracolumbar Fracture

作　　者：杨海云[1] 高忠礼[2] 邓树才[1] 刘欣[1] 吕工一[1] 刘建坤[1] 

机构地区：[1]天津医院脊柱外科,天津300211 [2]吉林大学中日联谊医院骨科,吉林长春130033

出　　处：《实用骨科杂志》2009年第7期487-490,共4页Journal of Practical Orthopaedics

摘　　要：目的评价经后路椎体部分切除钛网植入联合椎弓根螺钉治疗胸腰段不稳定骨折的效果。方法采用单纯后侧入路切除部分椎体植入钛网并联合椎弓根螺钉内固定方法治疗8例不稳定胸腰椎骨折。男6例,女2例,平均39.3岁;T11骨折1例,T12骨折3例,L1骨折3例,L2骨折1例。根据Denis分型,本组8例均为三柱骨折。平均后凸成角26.6°,平均椎管占位77.4%,平均椎体高度丢失70.6%。对手术时间、术中失血量、手术并发症以及术后神经功能改善程度进行评价。结果5例术后神经功能较术前无明显改善;2例ASIA评分由D提高到E,1例由C提高到D,椎体正常序列基本恢复,术后局部后凸成角平均恢复到5°（0～14°）。所有病例均未出现严重血管损伤以及神经症状加重等并发症。手术时间129～230 min,平均168 min。术中出血量1 650～3 650 mL,平均2 594 mL。结论不稳定胸腰椎骨折可采用单纯后侧入路切除部分椎体植入钛网并联合椎弓根螺钉内固定治疗,该方法操作简单、并发症较少并能提供三柱固定。Objective To evaluate the effect of three treatment of unstable thoracolumbar fracture. Methods columns stabilization only through posterior approach in the Eight patients（6 males and 2 females）with unstable thoracolumbar fracture were treated by the application of anterior titanium mesh and posterior pedicles screws stabilization instruments through only the posterior approach. All cases was identified as three column fracture according to Denis classification, preoperative spinal canal compromise was 77. 4%（range 50%～92%）, and the mean vertebral body height loss was 70.6%（range 55%～78%）. The mean preoperative kyphotic deformity was 26.6°（range 20°～35°）. Neurological improvement was assessed according to ASIA grading scale. We also recorded operation time ,blood loss, complications. Results 5 cases have no neurological function improvement postoperatively. In 2 cases ,the ASIA score improved from D to E and 1 case from C to D. The mean preoperative segmental kyphotic deformity of 26.6°（range 20°～35°） improved significantly to 5°（range 0°～14°） after surgery. The vertebral body restore the normal height. The operation time was median 174 min,range 130～215 min. The blood loss was median 2,594 mL,range 1 650～3 650 mL. There were no cases of vascular complication or neurological deterioration. Conclusion The application of anterior and posterior stabilization instruments through only the posterior approach is a satisfactory technique for the treatment of unstable thoracolumbar fracture. It is simple and can provide three-column fixation.

关 键 词：椎体切除 后侧入路 胸腰段骨折 脊柱内固定 

分 类 号：R683.2[医药卫生—骨科学]