经后路椎体次全切除及重建治疗严重胸腰椎骨折  

Corpectomy and reconstruction via single posterior approach for severe thoracic and lumbar fractures

作　　者：李建江[1] 马信龙[1] 邓树才[1] 郝永宏[1] 张晓林[1] 马毅[1] 赵合元[1] 

机构地区：[1]天津医院脊柱外科,天津300211

出　　处：《中华骨科杂志》2011年第7期761-766,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨经单一后路椎体次全切除、椎弓根钉固定结合前中柱钛网植骨一期三柱重建治疗严重胸腰椎骨折的临床效果。方法采用经后路椎体次全切除、椎弓根钉固定结合前中柱钛网植骨重建治疗严重胸腰椎骨折患者44例，男35例，女9例；年龄19-66岁，平均37-3岁；T11 1例，T12 5例，L1 20例，L2 11例，L3 5例，L4 2例。骨折按AO分型：A3型24例，B1和B2型共17例，C1型3例。神经功能ASIA分级：A级lO例，B级17例，C级10例，D级7例。通过对术前、术后即刻、术后2年时神经功能和矫形效果的比较分析临床疗效，总结早期并发症并分析其原因。结果44例患者获得随访，随访时间24-58个月，平均38．9个月。术后2年随访时，除1例术前ASIA分级为A级的患者损伤未恢复外，其余43例神经功能均有ASIA分级1-2级的恢复。术后影像学检查显示减压和复位效果满意。43例（97．7％）于末次随访时未见内固定松动征象，矫正度维持良好。并发症包括：术中大出血（〉1500m1）9例，一过性神经根损伤4例，脑脊液漏3例，固定松动钛网塌陷、矫正度严重丢失l例，钛网位置不良3例，医原性游离骨块遗留椎管内2例，浅层感染1例。结论经后路椎体次全切除及重建治疗严重胸腰椎骨折的方法具有减压充分，融合效果良好的优点，是一种较好的替代前、后路联合手术的术式。Objective To analyze the clinical results and early complications of corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation via a single posterior approach for severe thoracic and lumbar fractures. Methods Forty-four patients treated by reconstruction with titanium mesh cage implantation and pediele screw fixation via a single posterior were studied retrospectively. There were 35 males and 9 females, with an average age of 37.3 years （range, 19-66 years）. The injury segments include 1 case at Tu, 5 cases at Tn, 20 cases at L1, 11 cases at L2, 5 cases at L3 and 2 cases at L4. According to AO classification, there were 24 cases of A3, 17 cases of B1 and B2, and 3 eases of C1. According to ASIA, there were 10 cases of grade A, 17 cases of grade B, 10 cases of grade C and 7 cases of grade D. The neurologic function and effectiveness of correction of preoperative, immediate postoperative and 2 years follow-up were compared, and the clinical outcome and early complications were analyzed. Results The follow-up time was 24 to 58 months, mean 38.9 months. At the time of 2 years postoperation, 43 cases of incomplete neurologie deficit had improved 1 or 2 ASIA grades except 1 case of grade A. The results of decompression and reduction were satisfactory from the postoperative radiographic examinations. The correction maintained well and the implant loosening was not seen in 43 cases （97.7%） at the last follow-up. The complications include： excessive blood loss （〉1500 ml） in 9 cases, transient nerve root injury in 4, eerebrospinal fluid leakage in 3, instrumentation failure in 1, mesh cage malposition in 3, iatrogenic leaving of free bone granula into the canal in 2, and superficial infection in 1. Conclusion This technique is effective for decompression and fusion, less invasive than combined anteroposterior procedure, and may be another good alternative for the treatment of severe thoracic and lumbar fractures. The early complications are not rare, but most of them are

关 键 词：胸椎 腰椎 脊柱骨折 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]