Ⅰ期后前路内固定治疗严重胸腰椎骨折的疗效  

Efficacy of one-stage posterior-anterior approach for treatment of severe thoracolumbar fractures

作　　者：赵兴[1] 朱刃 徐文斌[1] 刘刚[1] 方向前[1] 范顺武[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016 [2]义乌市稠州医院骨科

出　　处：《中华创伤杂志》2017年第3期208-212,共5页Chinese Journal of Trauma

基　　金：浙江省医药卫生科技计划项目（2015119330）;浙江省教育厅科研项目（Y201636457）

摘　　要：目的探讨Ⅰ期后路短节段椎弓根内固定联合前路内固定术治疗严重胸腰椎骨折的疗效。方法采用回顾性病例系列研究分析2012年1月-2014年12月Ⅰ期后路短节段椎弓根内固定联合前路内固定术治疗严重胸腰椎骨折患者21例，其中男16例，女5例；年龄17～64岁[（38．7±11．4）岁]。损伤节段：T11 2例，T12 5例，L1 6例，L2 8例。骨折按AO分型：A型4例，B型7例，C型10例。胸腰椎损伤分类和严重度评分（TLICS）7～10分[（8．12±0．87）分]。神经功能采用Frankel分级：B级8例，C级11例，D级2例。记录手术时间、术中出血量，并观察神经功能改善、后凸畸形矫正、手术并发症等情况。结果手术时间180—360min[（234．5±57．3）min]，术中出血量260～950ml[（387．4±124．4）ml]。患者均获随访14～25个月[（19．8±3．5）个月]。18例Frankel分级至少改善1级。术前Cobb角为（-9．3±4．2）°，术后3d为（4．1±5．3）°，末次随访时为（4．0±4．9）°，术后3dCobb角较术前明显改善（P〈0．05），末次随访时与术后3dCobb角比较差异无统计学意义（P〉0．05）。无脑脊液漏、血管损伤、切口感染、神经功能恶化等术中和术后并发症发生。结论I期后路短节段内固定联合前路减压植骨内固定治疗严重胸腰椎骨折手术时间短、出血少，后凸畸形矫正满意，神经功能恢复良好，可作为严重胸腰椎骨折治疗的选择方案。Objective To observe the outcomes of one-stage posterior short-level pedicle screw fixation combined with anterior fixation of severe thoracolumbar fractures. Methods A retrospective case series study was performed on 21 patients with severe thoracolumbar fi＇actures stabilized by posterior short-level pedicle fixation combined with anterior internal fixation at one stage from January 2012 to December 2014. There were 16 males and 5 females, at age of 17 and 64 years [ （38.7 ± 11.4） years 1. The involved segments included T11 in 2 patients, T12 in 5, L1 in 6 and L2 in 8. For AO fracture classification, type A fractures were seen in 4 patients, type B in 7 and type C in 10. Thoracolumbar injury classification and severity score （TLICS） was （8. 12 ± 0. 87 ） points （ range, 7-10 points）. Frankel neurological performance scale was Grade B in 8 patients, Grade C in 11 and Grade D in 2. Operation time, blood loss, nerve function, kyphosis correction and complications were reported. Results Operation time was （234.5 ± 57.3 ） min （ range, 180-360 min）, and blood loss was （ 387.4 ± 124.4） ml （ range, 260-950 ml）. Time of follow-up was （ 19. 8 ± 3. 5 ） months （ range, 14-25 months）. Nerve function of 18 patients was improved by at least one Frankel scale. Cobb angle was （ 4. 1 ± 5.3 ） o at postoperative 3 days and （4.0 ± 4.9 ）° at the final follow-up, showing significant differences from that before operation [ （ - 9.3 ± 4.2 ） ° ] （ p 〈 0.05 ）. While the difference of Cobb angle did not differ significantly at postoperative 3 days and at final follow-up. No cerebrospinal fluid leakage, vascular injury, incision infection or nerve function deterioration occurred. Conclusion One-stage posterior short-level pedicle screw fixation combined with anterior decompression and bone graft fixation is characterized by short operation time, few blood loss, good correction of traumatic kyphosis and good neurological recovery, indicating a good surgical choice for seve

关 键 词：胸椎 腰椎 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]