前路手术治疗成人胸腰段Denis B型爆裂性骨折  

Anterior approach surgery for Denis type B thoracolumbar burst fractures in adults

作　　者：郑超[1] 伍骥[1] 黄蓉蓉[1] 初冬[1] 赵旭红[1] 虞攀峰[1] 尚咏[1] 李松林[1] 崔玉明[1] 范恒华[1] 

机构地区：[1]空军总医院骨科,北京100142

出　　处：《中华创伤杂志》2014年第7期669-674,共6页Chinese Journal of Trauma

摘　　要：目的 通过前路手术治疗胸腰段Denis B型爆裂骨折,对临床效果进行评估,分析及总结前路手术的应用价值. 方法 选取2007年1月-2012年12月胸腰椎Denis B型爆裂性骨折并伴有部分神经功能障碍患者28例.采用Oswestry功能障碍指数（Oswestry disability index, ODI）、美国脊髓损伤协会（American Spinal Injury Association,ASIS）功能评分和背痛视觉模拟评分（visual analogue scale,VAS）进行评价.影像学指标测量Cobb后凸角和伤椎单位前缘高度,CT矢状位测量椎管狭窄指数. 结果 平均随访时间为37.7个月.术前平均椎管狭窄指数45.4％,终末随访为3.8％.患者终末随访时临床症状及神经功能明显改善.Cobb后凸角由术前的平均22.9°降至终末随访时10.4°（P＜0.05）.伤椎单位前缘高度由术前平均30.3 mm抬高至终末随访时38.7 mm.ODI、VAS终末随访与术前比较,分别平均降低38.4分和7.3分（P＜0.05）,术后与终末随访比较差异无统计学意义.ASIS运动、感觉评分手术前后差异无统计学意义,终末随访与术前比较,分别平均增加23.0分和30.7分（P＜0.05）.无内固定失败. 结论 前路手术具有直视下手术、椎管减压充分、后凸畸形矫正、融合率高、固定节段短、早期康复等优势.Objective To investigate the effect of anterior surgery for Denis type B thoracolumbar burst fractures in adults.Methods Twenty-eight patients with Denis type B thoracolumbar burst fractures combined with partial neurologic deficit underwent anterior surgery between July 2007 and December 2012.Clinical evaluation comprised Oswestry disability index （ODI）,American spinal injury association （ASIS）,and visual analogue scale （VAS）.Radiological measurements included kyphosis Cobb＇ s angle,anterior vertebral body height,and canal stenosis index.Results Mean duration of follow-up was 37.7 months.Canal stenosis index improved from preoperative 45.4％ to 3.8％ at final follow-up （P ＜ 0.05）.All patients showed obvious improvements in clinical and neurological symptoms function at final follow-up.Mean kyphosis Cobb angle improved from preoperative 22.9°to 10.4° at final follow-up （P ＜ 0.05）.Mean anterior vertebral body height improved from preoperative 30.3 mm to 38.7 mm.ODI and VAS presented 38.4-and 7.3-point improvements respectively and both were not statistically different after operation and at final follow-up.ASIS motor and sense scores presented no statistical variations before and after operation,but separately increased by 23.0 points and 30.7 points at final follow-up （P ＜ 0.05）.No implant failed.Conclusion Anterior approach provides direct access for repair of the fracture,complete decompression of the vertebral canal,correction of kyphotic deformity,short-level fusion,and early rehabilitation.

关 键 词：脊柱骨折 骨折固定术 内 胸椎 腰椎 前路 

分 类 号：R687.3[医药卫生—骨科学]