经后路椎管侧前方潜行减压椎体内植骨内固定治疗胸腰椎骨折  

Effects of anterior vertebral canal undercutting decompression by posterior approach and transpedicular bone grafting on thoracolumbar fracture

作　　者：张招波 周小小[1] 李小亚[1] 马宁[1] 朱贤平[1] 滕晓[1] 

机构地区：[1]台州市中心医院骨科,浙江台州318000

出　　处：《全科医学临床与教育》2010年第2期134-136,共3页Clinical Education of General Practice

摘　　要：目的探讨对不稳定性爆裂型、骨折片侵及椎管容积>50%的胸腰椎脊柱脊髓损伤患者,经后路椎管侧前方潜行减压椎体内植骨内固定治疗的可行性及临床效果,总结技术要点。方法对39例不稳定性爆裂型、骨折片侵及椎管容积>50%的胸腰椎骨折伴脊髓损伤患者行后路椎管侧前方潜行减压、椎体内及后外侧植骨、椎弓根螺钉内固定术。结果39例患者均获随访,随访7～41月,平均(14.22±7.41)月。椎体前缘高度与原高度比由术前平均(48.42±5.38)%恢复到术后平均(92.23±2.49)%;椎体后缘高度与原高度比由术前平均(74.31±3.56)%恢复到术后平均(97.76±1.06)%;Cobb角由术前平均(19.47±3.94)°矫正到术后平均(3.96±1.87)°,手术治疗前后比较均有明显好转,差异均有统计学意义(t分别=48.62、39.40、22.24,P均<0.05)。神经功能根据Frankel分级评定,术后较术前有0～3级的恢复。其椎体高度无明显丢失,植骨全部融合,术后39例CT复查显示椎管矢状径得到有效扩大,脊髓压迫解除。结论经后路椎管侧前方潜行减压椎体内植骨内固定治疗不稳定性爆裂型、骨折片侵及椎管容积>50%的胸腰椎骨折是可行的。Objective To evaluate the clinical efficacy of anterior vertebral canal undercutting decompression by posterior approach and transpedicular bone grafting in the treatment of thoracolumbar burst fractures. Methods Thirty nine patients with unstable thoracolumbar burst fractures and vertebral canal volume 〉 50% and spinal cord injury were treated with anteriolateral vertebral canal undercutting decompression by posterior approach, transpedicular bone grafting and pedicle screw fixation. Results All of the 39 cases were followed-up for 7 to 41 months, average （14.22 ±7.41） months. The height of anterior vertebra restored from mean （48.42±5.38）% preoperatively to mean （92.23±2.49）% postoperatively, and the posterior vertebra restored from mean （74.31±3.56）% preoperatively to mean （97.76±1.06）% postoperatively. The cobb angle were corrected from mean （19.47±3.94）° preoperatively to mean （3.96±1.87）° postoperatively. The treatment had significant effects （t=48.62, 39.40, 22.24, P〈 0.05）.The neurological functions were improved for about 0 to 3 grades according to Frankel grading system, the heights of injured vertebrae weren＇t lost, and bone graft fused. CT scanner displayed sagittal diameters of vertebral canals were essential normal postoperatively, and all the compressions were relieved. Conclusions Using anteriolateral vertebral canal undercutting decompression by posterior approach and transpedieular bone grafting in thoracolumbar fracture were feasible.

关 键 词：胸腰椎骨折 短节段内固定 骨移植 潜行减压 

分 类 号：R687.3[医药卫生—骨科学]