经后路侧方减压椎体次全切三柱重建治疗胸腰椎爆裂骨折  

Vertebral full cut and three-column reconstruction for thoracolumbar burst fractures through posterior side decompression.

作　　者：韩毅[1] 贺仕雄[1] 姚国荣[1] 蔡力[1] 郑伟[1] 

机构地区：[1]广元市第二人民医院骨科,四川广元628000

出　　处：《四川医学》2013年第8期1187-1189,共3页Sichuan Medical Journal

摘　　要：目的探讨经后路侧方减压椎体次全切三柱重建治疗胸腰椎爆裂骨折临床疗效。方法对69例胸腰椎爆裂性骨折患者采用经后路侧方减压椎体次全切,椎管前方骨块切除减压、三柱重建技术进行手术治疗,采用美国脊髓损伤学会(ASIA)分级进行神经功能评估,通过术前、术后2周及术后12个月随访时的X线及CT片,比较椎管侵占率及Cobb角变化,评估椎管减压及复位情况。结果手术均顺利完成,手术时间2.3~3.5h,平均2.8h,术中出血500~1800ml,平均800ml,术中无神经及血管进一步损伤,术后2周支具保护下坐起或离床活动,并行早期康复训练,无感染及深静脉血栓等并发症。69例患者均获随访,平均随访18个月(12~24个月)。椎管矢状径侵占率术前29.7%~87.3%,术后2.78%~3.37%,Cobb角术前平均20.6°,术后2周2.3°。所有患者脊髓获得有效减压,ASIA分级改善1级者18例,改善2级者23例,8例无明显改善者术前均为A级,3例术前为E级者术后仍为E级。所有患者均未出现断钉,断棒、螺钉松动、椎体间支撑物松动下沉等并发症,植骨完全愈合。结论经后路椎体次全切三柱重建治疗胸腰椎爆裂骨折是安全,有效的方法,具备前后联合入路的优势。通过一个手术入路同时重建三柱稳定性,可以有效恢复椎体高度、椎管容积及Cobb角度,为不稳定胸腰椎爆裂骨折提供一种好方法。Objective. To discuss the clinical efficacy of vertebral full cut and three-column reconstruction tor thoraco- lumbar burst fractures through posterior side decompression. Methods To choose 69 patients with thoracolumbar burst fracture use the vertebral full cut through posterior side decompression , anterior bone resection decompression and the three-column reconstruc- tion to conduct the surgery. We use American Spinal Injury Association （ASIA） classification to assess the nerve function . Then compare spinal canal encroachment rate and Cobb angle changes and assess spinal decompression and reset conditions by X-ray and CT films of preoperative, two weeks after surgery and after 12 months following. Results the operations were successfully completed and the operation time was 2. 3 to 3.5h, an average of 2. 8h. The blood loss was 500- 1800ml, an average of 800ml And there were no further damage to nerves and blood vessels： To make patients sit up or out of bed two weeks after surgery by brace protection and doearly rehabilitation training. There were no complications such as infection and deep vein thrombosis. The 69 patients were followed up for an average following of 18 months （ 12 to 24 months）. The encroachment rate of sagittal diameter was preoperative 29.7 to 87.3% ,postoperative 2. 78 to 3.37% and the average Cobb angle was 20. 6°, then 2. 3°after two week. All cases were got effective decompression. The improvement in them were 18 cases 1 level and 23 cases 2 level by using ASIA classification . 8 case with no significant improvement remains Class A in the preoperative and another 3 case with Class E in the preoperative remains the Class E in the postoperative. No patients experienced complications such as broken nails, broken rods, loose screws, in- terbody supports losing or sinking and the bone sraft was completely healed. Con^lttsiort Three-column reconstruction for thoraco- lumbar burst fracture through posterior vertebral full cut is a safe, effective method and has the advantage of th

关 键 词：胸腰椎骨折 后路侧前方减压 重建 

分 类 号：R687.3[医药卫生—骨科学]