侧卧位一期前后联合入路治疗胸腰椎骨折  

Treatment of thoracolumbar fracture by an anteroposterior approach with the patient lying in the lateral position

作　　者：孙志波[1] 禹志宏[1] 孙晨[1] 江剑[1] 

机构地区：[1]湖北医药学院附属人民医院创伤骨科,湖北十堰442000

出　　处：《创伤外科杂志》2013年第3期220-222,共3页Journal of Traumatic Surgery

摘　　要：目的探讨侧卧位一期前后联合入路治疗严重胸腰椎爆裂骨折的临床效果。方法 2008年9月～2011年5月期间,笔者手术治疗32例成人严重胸腰椎爆裂骨折,Denis分型,D型22例,E型10例;术前神经功能按美国脊髓损伤协会(ASIA)分级:A级5例,B级13例,C级11例,D级3例。均采用侧卧位,先行后路椎板减压,椎弓根钉内固定撑开复位、恢复脊柱序列,前路同体位一期伤椎椎体次全切除、椎管减压、钛网植骨融合。术后定期随访,比较患者术前、术后影像学上Cobb角及椎管容积变化,手术前后ASIA分级变化,进行疗效评价。结果随访10～24个月,平均15个月。术前椎管占位平均68.5%,Cobb角平均34.3°,术后影像学检查显示减压及复位效果满意,椎管内占位骨块全部切除,Cobb角平均3.2°;除术前A-SIA分级A级的1例神经功能无恢复,其余31例神经功能均有1～2级的恢复。结论侧卧位一期前后联合入路治疗严重胸腰椎爆裂骨折可以获得满意的临床效果。Objective To investigate the clinical effectiveness of treatment of thoracolumbar burst fracture by an anteroposterior approach with the patient lying in the lateral position. Methods During Sep. 2008 to May 2011,32 adult patients were enrolled in this study. The Denis criteria showed D type in 22 cases,E type in 10; the classification defined by American Spinal Injury Association （ASIA} showed grade A in 5 cases, grade B in 13, grade C in 11, and grade D in 3. All the patients were in lateral position, posterior laminectomy and pedical screw insertion were performed, followed by subtotal resection of vertebral body, grafted bone fusion with titanium mesh. Patients were regularly followed up. Patients＇ Cobb angle, volume rate of spinal canal and neurological status were reviewed preoperatively and postoperatively. Results All the 32 cases were followed up for a mean time of 15 months. The average spinal canal occupation ratio was 68. 5% and the average segmental Cobb angle was 34. 3~pre- operatively. The results of decompression and reduction were satisfactory from the postoperative radiographic exami- nations. After resection of the vertebral body, the average segmental Cobb angle was 3.2~ post-operatively, and neurology function was restored in all cases except 1 case of grade A defined by ASIA criteria. Conclusion Treat- ment of thoracolumbar burst fracture by an anteroposterior approach with the patient lying in the lateral position can result in good clinical effectiveness.

关 键 词：胸腰椎骨折 椎体切除 减压 内固定 

分 类 号：R683.2[医药卫生—骨科学]