后路经侧前方减压单节段融合治疗Denis B型胸腰椎爆裂骨折的临床疗效观察  

Observation of clinical efficacy of posterior lateral anterior decompression combined with single segment fusion in the treatment of denis B thoracolumbar burst fracture

作　　者：贺旭[1] 马雪峰[1] 刘恺[1] 阮烨[1] 

机构地区：[1]深圳平乐骨伤科医院坪山院区,广东深圳518122

出　　处：《中国现代医生》2016年第28期79-82,共4页China Modern Doctor

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钛网支撑椎间融合,短节段固定治疗Denis B型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～2014年3月收治的Denis B型胸腰椎爆裂骨折26例,采用后路经侧前方椎体次全切除椎管减压,保留伤椎完整的下终板,钛网植骨重建前中柱,单节段融合结合短节段椎弓根固定治疗。采用ASIA评分观察患者术前及末次随访时的神经功能恢复状态。比较患者术前术后及末次随访时的椎体前缘高度、损伤节段的Cobb角恢复情况,观察椎管重建、植骨融合和内固定情况。结果 随访24～60个月,26例术后、末次随访与术前ASIA评分有显著提升;计算获得术前伤椎前缘高度丢失（65.46±12.17）%,术后（5.22±1.70）%;Cobb角术前（25.30±7.80）°（16°～34°）,术后（3.60±1.70）°（1°～5°）,末次随访时Cobb角（3.80±2.20）°（2°～6°）,术后、末次随访与术前比较差异均有高度统计学意义（P〈0.01）;术前椎管占位（61.73±1.29）%,术后（3.20±1.36）%。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,可以维持脊柱良好稳定性,融合可靠、并发症少等特点,短期疗效确切。Objective To explore the value and curative effect of posterior thoracolumbar vertebral lateral anterior de- compression combined with single segment inter-body fusion cage and short segment fixation in the treatment of Denis B thoracolumbar burst fracture. Methods A retrospective analysis was conducted among 26 cases of Denis B thora- columbar burst fracture treated from March 2008 to March 2014. The posterior lateral anterior corpectomy decompres- sion was conducted and the vertebral endplate was preserved intact. Titanium mesh bone was grafted for the reconstruc- tion of anterior column and single segment fusion was combined with pedicle fixation. ASIA score was used to observe the recovery of neurological function in patients before surgery and at the last follow-up. The height of anterior verte- bral body and the Cobb angle of the injured segment of the patients before the operation, after the operation and at the last follow-up were compared. The spinal canal reconstruction, bone graft fusion and internal fixation were observed. Results The length of follow-up was 24 to 60 months. 26 cases were significantly improved in ASIA score at the last follow-up and post-operation than that of the pre-operafion （P〈0.01）. The loss of vertebral anterior height was （65.46±12.17）% before operation and （5.22±1.70）% after operation by calculation. The Cobb angle was （25.30±7.80） de- grees （16 to 34 degrees） before operation, （3.60±1.70） degrees （1 to 5 degrees）after operation, and （3.80±2.20） （2~6 de- grees） at the last follow-up. The differences of Cobb angle at the last follow-up, post-operation and pre-operation were statistically significant（P〈0.01）. Preoperative spinal canal occupying was （61.73±1.29）% before operation and （3.20±1.36）% after operation. Conclusion Posterior lateral anterior decompression combined with single segment intervertebral fusion reconstruction in the treatment of Denis B thoracolumbar burst fracture can achieve complete decompression a

关 键 词：胸腰椎骨折 后路经侧前方减压 椎体次全切 椎间融合 

分 类 号：R687.3[医药卫生—骨科学]