经后侧入路重建前中柱技术治疗腰椎爆裂骨折——附33例报告  

Treatment of lumbar burst fractures with the technique of reconstructing anterior and middle column by posterior approach

作　　者：韩卫东[1] 靳松[1] 黄爱军[1] 彭建强[1] 

机构地区：[1]广东医学院附属福田医院(深圳市第四人民医院)骨科,深圳518033

出　　处：《新医学》2013年第6期400-404,共5页Journal of New Medicine

基　　金：深圳市科技项目(201102080)

摘　　要：目的探讨经后侧入路植入钛网重建椎体前中柱技术在治疗腰椎爆裂骨折中的临床价值。方法选择33例腰椎爆裂骨折患者,采用后侧入路截除横突显露前方骨折椎体,从侧方清除前中柱移位骨折碎块。行椎管扩大减压成形后,从椎体侧方置入填塞自体松质骨的钛网重建椎体前中柱,结合后路短节段椎弓根螺钉系统固定骨折椎邻近上下节段椎体,椎板及横突间植骨融合。记录每例患者不同时期的前侧脊柱高度、脊柱后凸畸形程度、椎管内占位及植骨融合情况。结果所有患者均获随访,随访时间6～39个月,平均23个月。患者康复顺利,无局部疼痛和椎体活动受限。骨折椎椎体高度术前压缩(51.0±22.5)%,术后恢复至正常高度的(96.0±5.5)%,手术前后比较差异有统计学意义(P<0.01),椎管内压迫完全解除,脊柱生理曲度恢复,椎弓根螺钉固定牢固,植骨融合良好,没有出现椎体高度再丢失病例。神经功能按ASIA神经损伤评分标准进行评定,A级1例,B级2例,C级2例,D级6例,E级22例。无发生断钉、断棒等并发症。结论经后侧入路植入钛网重建前中柱技术可操作性强,能有效恢复椎体的正常高度,矫正后凸畸形,在治疗腰椎爆裂骨折中有较高临床价值。Objective To explore the practical value of lumbar burst fractures with the technique of reconstructing anterior and middle column by posterior approach. Methods Thirty-three cases of lumbar burst fractures were treated as the following surgical procedures： The vetebral arch, articular joint and transverse process were exposed by routine posterior approach. The transverse process was resected to get access to the lateral side of the injuried vetebral body. After clearance of all the displaced fracture fragments and decompres- sion of the spinal canal, the titanium mesh packed with autografts were implanted from lateral side to recon- struct the anterior and middle column. The adjacent above and below vetebral body were fixed by transpedicular screws, accompanied by Loss of anterior vertebral height, degree of kyphotic deformity, comprised spinal canal and bone fusion were analyzed at different phases. Results All cases were followed up in an average of 23 months （from 6 to 39 months）. The clinical results was satisfying, without pain or activity restriction. The height of the injuried vetebral body were restored from （51.0 ± 22. 5 ） % preoperative to （96. 0 ± 5.5 ） % post-operative （P 〈 0. 05）. The natural spinal curvatures and spinal canal were restored. And the internal fixation instruments were stable. No recurrent kyphotic deformity occurred. Good bone fusion was observed. The nerve function according to ASIA （American Spinal Injury Association） classification assessment, showed 1 case of grade A, 2 grade B, 2 grade C, 6 grade D, 22 Grade E. There was no complication as broken screw or broken stick. Conclusions The technique of implanting the titanium mesh packed with autografts by posterior ap-proach was very effective on reconstructing the anterior and middle column in treating lumbar burst fracture.With this technique, the vertebral body height and spinal physiological curve could be restored effectively.

关 键 词：腰椎 爆裂骨折 三柱理论 手术入路 

分 类 号：R687.3[医药卫生—骨科学]