后路单节段侧前方减压前柱重建术治疗Denis B型胸腰椎爆裂骨折  

Posterior single segment anterolateral deeompression and anterior column reconstruction for type Denis B thoracolumbar burst fractures

作　　者：高志朝[1] 王梅[2] 张妙林[1] 孟永俊[1] 祝卫民[3] 张春[3] 

机构地区：[1]杭州师范学院医学院附属余杭医院骨一科,311100 [2]杭州师范学院医学院附属余杭医院ICU,311100 [3]浙江省立同德医院骨科

出　　处：《中华创伤杂志》2011年第3期249-253,共5页Chinese Journal of Trauma

摘　　要：目的探讨后路小切口单节段侧前方减压前柱重建术治疗DenisB型胸腰椎爆裂骨折的可行性及临床疗效。方法回顾性分析2007年8月-2009年8月采用经后路小切口椎弓根钉内固定、单间隙侧前方减压、钛网植骨融合重建前柱治疗DenisB型胸腰椎爆裂性骨折21例，其中男15例，女6例；年龄23～50岁，平均35．6岁。骨折累及节段：T126例，L，11例，L2 3例，L1 1例。术前椎管占位率平均62．5％，所有患者惟体前中柱压缩均≤50％，CT平扫示椎体下份及下终板骨结构正常。通过术前、术后即刻及末次随访时X线、CT片及神经学检查，观察骨折复位、植骨融合、神经功能恢复、矫正丢失、腰椎活动情况及相邻椎间盘退变等情况。结果本组患者手术时间1．5～3．2h，平均2．1h。出血量350—1000ml，平均580ml。21例患者术后均获4～26个月（平均10．3个月）随访。椎体问融合时间约4tv6个月，随访中椎体高度无丢失。无断钉、断棒或内置物松动、移位等并发症，神经功能均有1～2级改善。结论只要适应证选择合适，后路小切口单节段侧前方减压前柱重建术具有操作安全简便、手术创伤小、融合节段少、术后康复快的优点，是一种安全有效的手术方式。Objective To investigate the feasibility and clinical effect of the posterior single seg- ment anterolateral decompression and anterior column reconstruction in the treatment of thoracolumbar burst fractures. Methods A retrospective study was done on 21 patients with type Denis B thoroealumbar burst fractures who were treated by posterior approach minimal incision pedicle screw fixation, single segment anterolateral decompression and titanium mesh and bone graft from August 2007 to August 2009. There were 15 males and six males at mean age of 35.6 years （range, 23-50 years）. The involved segments included TI2 in six patients, L1 in 11, L2 in three, and L3 in one. The preoperative spinal canal en- croachment rate was 62.5% and the anterior-middle vertebral compression of all patients was less than 50%. CT scanning showed normal vertebral body and inferior endplate structure. The fracture reduction, graft fusion, neurological function recovery, correction loss, lumbar activities and adjacent lumbar disc degeneration were observed through preoperative, immediate postoperative and final follow up X-ray, CT and neurological examinations. Results The operation duration was 1.5-3. 2 hours （ average 2. 1 hours） , with the bleeding of 350-1 000 ml （ average 580 ml）. All the patients were followed up for 4-26 months （ average 10.3 months） , which showed that the vertebral fusion time was 4-6 months, with no loss of the vertebral height, implant breakage, loosening or extrusion. The nerve function was improved for 1- 2 grades. Conclusions With correct selection of the indications, the posterior single segment anterolateral decompression and anterior column reconstruction is a reliable fixation, for it takes advantages of simple operation, minor trauma, less fusion segments and fast recovery.

关 键 词：脊柱骨折 胸椎 腰椎 重建 

分 类 号：R687.3[医药卫生—骨科学]