胸腰椎严重爆裂性骨折经后路减压钛网植骨内固定手术重建脊柱前、中柱稳定性的临床研究  

Clinical study on operation treatment of the severe burst fractures of the thoracolumbar spine through titanium rete bone-transplanting and internal fixation by posterior decompression in reconstructing the stability of anterior and middle columns

作　　者：于鑫[1] 杨申[2] 魏开斌[1] 冀承波[3] 

机构地区：[1]泰安市中心医院脊柱关节外科,山东省271000 [2]泰安市中心医院神经内科,山东省271000 [3]泰安市中心医院肿瘤外科,山东省271000

出　　处：《中华临床医师杂志（电子版）》2015年第8期1-4,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：山东省自然科学基金(ZR2014HL037);泰安市科技发展计划(2014-05C)

摘　　要：目的：研究经后路减压钛网植骨内固定手术方式治疗胸腰椎严重爆裂性骨折的临床疗效，探讨其在重建脊柱前、中柱稳定性中的适应证。方法选取泰安市中心医院骨科收治的94例胸腰椎严重爆裂性骨折患者，分为前路手术及后路手术两组，均给予完整12～48个月随访，对术前术后多项临床指标变化进行系统的统计学分析比较。结果后路手术组术中出血量为（893.31±134.15）ml，手术时间为（247.36±18.72）min，VAS疼痛评分后路手术组由术前5.78±1.27下降至术后2.41±0.73，术前、术后对肺功能的影响指标上，均明显优于前路手术组，与之比较均有统计学差异（P＜0.05）；后路手术组在术前及术后随访时椎体前、后缘高度比值及其脊柱矫正度和随访丢失率，后凸成角及其脊柱矫正率和随访丢失率，椎管容积，术前、术后的神经功能 ASIA 评分，与前路手术组相比较不具有统计学差异（P＞0.05）。结论治疗胸腰椎严重爆裂性骨折，经后路减压钛网植骨内固定的手术方式通过相对简洁直观的后方手术入路及操作达到了充分减压重建、牢靠固定的前路手术效果，而在术中出血量及手术用时，术后疼痛症状的发生及改善，术前术后肺功能的干预影响，并发症的出现方面则较前路手术有着明显的优越性。Objective To evaluate the clinic effect of the posterior decompression, bone graft and titanium rete internal fixation of the severe thoracolumbar spine burst fractures. To explore the indications to reconstruct the stability of the anterior and middle columns. Methods 94 cases of severe thoracolumbar spine burst fractures treated in Taian Central Hospital were included in this study, which were divided into 2 group of anterior approach group and posterior approach group. Lots of observation indexes of preoperative and postoperative with 12-48 months followed up were statistics analyzed systematically. Results For posterior approaches group, the intraoperative blood loss was （893.31±134.15） ml, and the operation time was （247.36±18.72）min, and the VAS score was declined from 5.78±1.27 to 2.41±0.73. There was significant difference between two groups （P〈0.05） in intraoperative blood loss, operation time, VAS score and lung function, and there was no significant difference between two groups （P〉0.05） in the height ratio of vertebra anterior border and posterior border, the spinal correction, follow-up loss rate, kyphosis angle, vertebral canal volume, neural function grade of ASIA. Conclusion To treat of severe thoracolumbar spine burst fractures, the posterior decompression, bone graft and titanium rete internal fixation has the same effect in decompression, reconstruction and fixation with the anterior approaches while the operating is much considered. Otherwise, the posterior approach surgery has advance in intraoperative blood loss, operation time, VAS score and lung function.

关 键 词：脊柱骨折: 后路减压钛网植骨内固定 脊柱前 中柱稳定性: 适应证 

分 类 号：R687.3[医药卫生—骨科学]