手术治疗下腰椎爆裂性骨折合并神经损伤的临床疗效分析  

Clinical outcomes of lower lumbar burst fracture combined with nerve injury treated by surgery

作　　者：彭自强 肖增明[2] 

机构地区：[1]湖南省永州市中心医院脊柱外科,湖南永州425000 [2]广西医科大学第一附属医院脊柱骨病科,广西南宁530000

出　　处：《中国现代医学杂志》2014年第24期57-60,共4页China Journal of Modern Medicine

摘　　要：目的评价下腰椎爆裂性骨折合并神经损伤患者手术治疗后的临床疗效和影像结果。方法回顾性分析2004年1月-2010年6月因下腰椎爆裂性骨折合并神经损伤在湖南省永州市中心医院手术治疗,同时随访2年以上的患者。通过疼痛、Frankle分级评价临床疗效,后路手术患者通过测量术前、后及随访时的椎体前后高和后凸角评价影像学结果,前路手术患者通过二维CT了解骨性愈合情况,记录并发症。结果随访2年以上患者36例,随访时间为24-69月（平均36.8月）,其中29例行后路切复（或减压）内固定,7例行前路减压植骨融合内固定术。术后疼痛评分P1：13例;P2：20例;P3：3例。神经功能分级：2例完全损伤患者无恢复外,其他患者均有不同程度恢复。椎体前高、后高及后凸角分别由术前21.34 mm,29.71 mm,12.70°纠正带术后30.40mm,30.99 mm,0.54°,均较术前有明显差异。而末次随访和术后比较无显著性差异。2例患者发生脑脊液漏,2例患者发生螺钉断裂,4例前路手术患者术中失血〉1 000 mL,予以输血治疗。结论对于下腰椎爆裂性骨折伴神经损伤患者,手术治疗不仅可以矫正畸形,而且可以明显改善患者神经功能。总体来说,无论后路还是前路手术都是安全可行的。【Objective】To evaluate the clinical outcomes and imaging results of surgical treatment for lower lumbar burst fracture combined with nerve injury patients.【Methods】Retrospective analyze lower lumbar burst fracture combined with nerve injury patients treated in our department between January 2004 and June 2010, the duration of follow up more than 2 years was included. The degree of pain and Frankle classification was used to assess the clinical outcomes, the anterior/posterior height and kyphotic angle of fractured vertebra was measured on pre-/post-operative and last follow up radiography of 29 posterior approached patients, 2D-CT was used to assess the result of bone union. Complications were also recorded to evaluate the safety of surgery. 【Results】36 patients were followed up more than 2 years, range from 24 to 69 months（averaged 36.8 months）. 29 of them were underwent with posterior approached surgery, and 7 of them were underwent anterior approached surgery. The pain degree of them at last follow up was： P1（13 cases）, P2（20 cases）, P3（3 cases）. Except 2 patients with complete nerve injury（Frankle of A）did not have neural functional recovery, the other patients had neural functional recovery at least one degree of Frankle classification. The anterior/posterior height and kyphotic angle of fractured vertebra was corrected from preoperative 21.34 mm, 29.71 mm, 12.70° to 30.40 mm and 30.99 mm, 0.54° postoperatively, respectively. The value of them at last follow up had no significant different with post-operation. 2 patients has developed cerebrospinal fluid leakage after operation, 2 patients had screws breakage, and 4/7 patients with anterior surgery had blood loss more than 1000 mL was underwent autoblood transfusion.【Conclusions】For lower lumbar burst fractures combined with nerve injury patients, surgery could not only correct the deformities, but also improve neurological function significantly. It is safety of both posterior and anterior approached surgery.

关 键 词：下腰椎 爆裂性骨折 神经损伤 外科手术 

分 类 号：R687.3[医药卫生—骨科学]