经有限切口腹膜外入路手术治疗下腰椎爆裂骨折  

Retroperitioneal Anterior Approach Operation of Lower Lumbar Fracture through Limited Incision:A Report of 16 Case

作　　者：林建聪[1] 严康宁[1] 李应国[1] 郑毅全[1] 郑亚才[1] 

机构地区：[1]福建医科大学附属漳州市医院骨科,福建漳州363000

出　　处：《实用骨科杂志》2010年第11期807-810,共4页Journal of Practical Orthopaedics

摘　　要：目的评价有限切口腹膜外入路手术治疗下腰椎爆裂性骨折的治疗效果。方法回顾性分析有限切口腹膜外入路手术治疗的16例严重下腰椎爆裂性骨折。主要损伤节段：L39例,L46例,L51例。按AO标准分类,A类（压缩）8例,B类（分离）2例,C类（扭转）6例。所有病例均行有限切口腹膜外入路伤椎部分切除、椎管减压、植骨融合及钛板内固定。分别比较术前与术后即刻的影像学指标变化及术前与术后8个月时神经功能的变化。结果本组随访850个月,平均16个月。术后即刻影像学显示,伤椎椎体前高由术前平均43.31%恢复至94.25%（P〈0.01）,椎管受堵指数由术前平均2.69恢复至0.19（P〈0.01）。有神经损伤者在术后8个月时出现一级以上的恢复。结论对于严重的下腰椎爆裂性骨折,采用有限切口腹膜外入路进行减压和固定完全可以达到良好的治疗效果。Objective To investigate the clinical effects of retroperitioneal anterior approach operation of lower lumbar fracture through limited incision.Methods Clinical data of 16 cases of serious lower lumbar burst fracture were analyzed retrospectively.The main injured segments were L3 in 9 cases,L4 in 6 cases and L5 in 1 cases.Fracture types according to AO classification were type A（compression） in 8 cases,type B（distraction） in 2 case and type C（retortion） in 6 cases.All the 16 cases were treated with retroperitioneal anterior decompression,bone graft fusion and internal fixation through limited incision.The imaging index of preoperation and postoperation as well as neurologic status of preoperation and 8 months of postoperation were compared respectively.Results All the cases had been followed up for an average of 16 months（8～50 months）.The instant postoperative imaging index showed obvious improvement on the injured body height（from 43.31% preoperatively to 94.25%,P〈0.01） and the canal encroachment index（from 2.69 preoperatively to 0.19,P〈0.01）.All those with neurologic deficit were improved above Asia grade one.Conclusion Retroperitioneal anterior decompression and internal fixation through limited incision are successful in treating serious lower lumbar burst fractures.

关 键 词：下腰椎骨折 神经损伤 前路手术 内固定 

分 类 号：R683.2[医药卫生—骨科学]