后路经侧前方椎管减压单节段融合治疗胸腰椎爆裂骨折疗效观察  

Curative effect of anterolateral single segmental vertebral canal decompression and interbody titanium mesh reconstruction with posterior approach for thoracolumbar burst fractures

作　　者：陈晓东[1] 易小波[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518010

出　　处：《中国骨与关节损伤杂志》2013年第9期805-807,共3页Chinese Journal of Bone and Joint Injury

基　　金：广东省医学科研基金(A2013625)

摘　　要：目的探讨胸腰椎后路经侧前方椎管减压单节段椎间融合短节段固定治疗胸腰椎爆裂骨折的疗效及价值。方法回顾性分析自2008年3月~2010年5月收治的16例Denis B型胸腰椎爆裂骨折,采用后路经侧前方椎管减压、单节段椎间融合结合伤椎上下邻椎椎弓根固定治疗。结果随访时间29~54个月,平均38个月,16例术后、末次随访与术前比较Frankel神经分级有显著提升(P<0.01)。术前伤椎前缘高度10~18 mm,平均14 mm,术后25~40 mm,平均32 mm,末次随访同术后;伤椎Cobb角术前19~32°,平均22°,术后3^-2°,平均2°,末次随访同术后,X线结果术后、末次随访与术前比较,差异有显著统计学意义(P<0.01)。末次动力位X线片及CT重建显示腰椎融合率100%,未发现钛网移位、螺钉松动。结论后路经侧前方椎管减压单节段椎间重建融合用于治疗Denis B型胸腰椎爆裂骨折具有减压彻底、融合可靠、并发症少等特点,短期疗效确切。Objective To explore the effect of anterolateral single segmental vertebral canal decompression and interbody titanium mesh reconstruction with posterior approach for thoracolumbar burst fractures. Methods From March 2008 to May 2010,16 patients suffering thoracolumbar burst fractures （Denis type B） underwent anterolateral single segmental vertebral canal decompression by resecting transverse process, damage disc and upper end-plate and interbody titanium mesh reconstruction and segmental pedicle screw f＇Lxation adjacent to the wounded vertebra with posterior approach. Results All patients were followed up for an average of 38 months （range,29～54 months）. In 16 patients, Frankel grading was upgraded signifieanfly（P 〈0.01）. The average vertebral anterior border height changed was 14 mm on average（range, 10～28 ram）,while 32 ram（range, 25～40 mm） postoperatively and the same at final follow-up. The Cobb＇s angle of the vertebral with fracture was 22° on average（range, 19～32°） ,while 2°（range ,3～-2°） postoperatively and the same at final follow-up. They all showed significant differences （P 〈0.01）. The fusion rate was 100% observed on dynamic X-ray photo and sagital reconstruction of CT. No titanium mesh sinking and screw shifting was detected. Conclusion The operation of anterolateral single segmental vertebral canal decompression and interbody titanium mesh reconstruction with posterior approach to treat thoracolumbar burst fractures （Denis type B）, has the advantages of thorough spinal cord decompression, satisfactory fusion, and less complication, and shows a certain short-term curative effect.

关 键 词：胸腰椎骨折 后路侧前方减压 椎体部分切除 椎体间融合术 

分 类 号：R683.2[医药卫生—骨科学] R608[医药卫生—外科学]