后路单侧侧前方椎体次全切除钛网重建椎体治疗高原胸腰椎爆裂骨折  

Posterior unilateral antero-lateral subtotal corpectomy and titanium mesh reconstruction for the treatment of thoracolumbar burst fractures in high altitude

作　　者：殷作明[1] 林秀来[1] 李素芝[1] 熊国忠[1] 汤建林[1] 刘建伟[1] 

机构地区：[1]西藏军区总医院骨科全军高原战创伤救治中心,西藏拉萨850007

出　　处：《创伤外科杂志》2010年第1期28-31,共4页Journal of Traumatic Surgery

摘　　要：目的探索创伤小、脊髓减压彻底、术后脊柱三柱即刻稳定、患者可早期活动的治疗高原胸腰椎爆裂性骨折的手术方案。方法42例高原胸腰椎爆裂骨折患者,经后路单侧行椎体次全切除、脊髓环形减压、钛网支撑植骨重建前中柱及椎弓根钉后柱内固定。采用美国脊柱损伤学会(ASIA)分级进行神经功能评估,通过X线及CT片评估骨折复位、减压及骨融合情况。结果手术均顺利完成,平均手术时间2.7小时;平均出血量740ml。术后发生脑脊液漏3例,无其它严重并发症发生。随访患者植骨融合,内固定无松动、断裂,椎体的高度、曲度和椎管容积无明显丢失。除A级患者外,其它各级患者神经功能均有不同程度的恢复。结论后路单侧椎体减压重建脊柱三柱稳定性手术具有创伤小、脊髓减压彻底、脊柱前中后柱即刻稳定等特点,可有效恢复椎体高度、脊柱的生理曲度、椎管容积和脊柱即刻稳定性,是治疗高原胸腰椎爆裂骨折的理想手术方式。Objective To explore an operation method with less injury,thorough spinal cord decompression,prompt post-operative three-column stability of spine and early movement for patients with thoracolumbar burst fractures in high altitude.Methods Totally 42 patients with thoracolumbar burst fractures in high altitude accepted posterior unilateral subtotal corpectomy,annular decompression of spinal cord,titanium mesh bone graft for reconstruction of anterior and middle column combined with pedicle instruments fixation.Spinal cord injury was evaluated with ASIA grade criterion.Reduction,decompression and fusion of fractures were evaluated through X-ray and computer tomography.Results All operations were completed successfully.The mean operation time was 2.7 hours and the mean blood loss was 740 ml.Cerebrospinal fluid leakage occurred in 3 patients.No other severe complications were observed.Bone graft fusion was observed in follow-up patients.No looseness and rupture of internal fixation,no obvious loss of vertebral height,spinal radian and vertebral canal volume were observed.Nervous function improved in different degree in all patients except those who had the nervous function of grade A.Conclusion The operation of posterior unilateral subtotal corpectomy and reconstruction of spinal three-column stability has the advantages of less injury,thorough spinal cord decompression,prompt post-operative three-column stability of spine,and can effectively restore vertebral height,vertebral canal volume,physiological radian and prompt stability of spine.It is an ideal operation method for the treatment of thoracolumbar burst fractures in high altitude.

关 键 词：胸腰椎骨折 椎体切除 高海拔 

分 类 号：R683.2[医药卫生—骨科学]