后路单侧侧前方减压钛网重建结合椎弓根钉内固定治疗胸腰椎爆裂骨折  

Reconstruction and short-segment stabilization by posterior approach anterolateral decompression for treatment of severe thoracolumbar burst fractures

作　　者：王洪[1] 易小波[1] 任志宏[1] 蔺福辉[1] 胡鑫华[1] 陈晓东[1] 贺旭[1] 

机构地区：[1]深圳平乐骨伤科医院脊柱外科,广东省深圳市518001

出　　处：《中国骨与关节损伤杂志》2012年第11期987-989,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨经后侧入路侧前方减压椎体前中柱钛网重建后路椎弓根内固定治疗胸腰椎重度爆裂骨折的安全性及疗效。方法对28例胸腰椎爆裂骨折采用经后路单侧行椎体次全切除、椎体270°减压、钛网支撑植骨重建前中柱及椎弓根钉内固定。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3.2 h;平均出血量1 200 ml。术后发生脑脊液漏2例,术后1例发生神经根牵拉伤。所有患者植骨融合,内固定无松动、断裂,椎体的高度、椎管容积无明显丢失。大部分患者神经功能有不同程度的恢复。结论采用后路侧前方减压椎体重建短节段内固定治疗重度胸腰椎爆裂骨折具有创伤小、安全性高、减压彻底、脊柱三柱即刻稳定等优点,临床疗效满意。Objective To evaluate feasibility and therapeutic effect of surgery of posterior 270 decompression and reconstruction for the treatment of thoracolumbar injury with severe thoracolumbar burst fractures. Methods All of 28 patients with thoracolumbar burst fractures were treated with unilateral subtotal vertebraectomy through only the posterior approach, 270 decompression, titanium cage supporting bone autograft to reconstruct the anterior and middle column, pedicles screws stabilization. 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 3.2 hours and the mean blood loss was 1 200 ml. Cerebrospinal fluid leakage occurred in 2 patients. One case was involved in iatrogenic nerve root injury. No other severe complications were observed. No looseness and rupture of internal fLxation, no obvious loss of vertebral height, spinal radian and vertebral canal volume were observed. Nervous function improved in different degree in most of the patients. Conclusion The operation of reconstruction and short-segment stabilization by anterolateral posterior approach decompression for the treatment of severe thoracolumbar burst fractures has the advantages of less injury, higher safety, complete decompression, immediate three-column stability of spine, with satisfactory clinical efficacy.

关 键 词：胸腰椎骨折 后路侧前方减压 椎体切除 

分 类 号：R683.2[医药卫生—骨科学]