椎旁肌及后正中椎板剥离联合入路在合并脊髓损伤胸腰段骨折中的应用  

Paraspinal muscle approach plus dorsomedian laminectomy approach for thoracolumbar fractures with spinal cord injury

作　　者：张哉炯[1] 张敬良[1] 张雷[1] 韦振兑 

机构地区：[1]广州中医药大学顺德和平外科医院骨二区,广东省佛山市528308

出　　处：《中华创伤骨科杂志》2017年第3期261-264,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨椎旁肌入路置钉及后正中入路单节段椎板剥离椎管减压治疗合并脊髓损伤胸腰椎骨折的疗效。方法回顾性分析自2013年2月至2015年9月收治的21例合并脊髓损伤需椎管减压的胸腰椎骨折患者资料，男15例，女6例；年龄20～54岁，平均33．2岁；损伤部位：T11 2例，T12 6例，T12合并L11例，L17例，L2 5例。脊髓损伤情况按照美国脊髓损伤协会（ASIA）分级：A级1例，B级3例，c级8例，D级9例。所有患者在采用椎旁肌入路置钉的基础上，采用后正中入路单节段椎板剥离椎管减压的方法。结果所有患者手术时间平均为（116．1±24．5）min，术中出血量平均为（580．7±80．8）mL；术后3d的疼痛视觉模拟评分（VAS）、伤椎前缘高度、后凸cobb角均较术前改善，差异有统计学意义（P〈0．05），末次随访时VAS评分、日本骨科协会（JOA）评分、伤椎前缘高度、后凸cobb角均较术前改善，差异有统计学意义（P〈0．05）。JOA评分改善率：优12例，良6例，可3例。末次随访时ASIA分级：B级1例，C级2例，D级6例，E级12例。结论椎旁肌入路置钉及后正中入路单节段椎板剥离椎管减压治疗合并脊髓损伤的胸腰椎骨折具有创伤小、出血少、操作简单、复位优良，固定可靠、恢复快等优点，是一种可供选择的治疗胸腰椎骨折的好方法。Objective To observe the clinical efficacy of screwing via the paraspinal muscle ap- proach plus single-segment laminectomy decompression via the dorsomedian approach for thoracolumbar frac- tures complicated with spinal cord injury. Methods From February 2013 to September 2015, 21 patients with thoracolumbar fracture plus spinal cord injury were treated at our department. They were 15 men and 6 women, aged from 20 to 54 years （average, 33.2 years）. The injury was located at Tll in 2 cases, at T12 in 6, at T12 and L1 in one, at L1 in 7 and at L2 in 5; the injury was rated as grade A in one case, grade B in 3 cases, grade C in 8 and grade D in 9 according to the American Spinal Injury Association （ASIA） grading system. A1 the patients were treated by screwing via the paraspinal muscle approach followed by single-segment laminectomy decompression via the dorsomedian approach. Results The operation time averaged 116. 1 ＋ 24.5 minutes and the amount of bleeding 580. 7 ＋ 80. 8 mL. At 3 days after surgery and the final follow-up, their visual analogue scale （VAS） score, anterior vertebral height and cobb angle were significantly improved in comparison with the preoperative values （ P 〈 0. 05） . At the final follow-up, their Japanese Orthopaedic Association （JOA） the score were also significantly better than the preoperative one （ P 〈 0. 05 ）, giving 12 excellent cases, 6 good ones and 3 fair ones. Their ASIA grading at the final follow-up showed one case of grade B, 2 cases of grade C, 6 cases of grade D and 12 cases of grade E. Conclusion Treatment of thoracolumbar fractures complicated with spinal cord injury by crewing via the paraspinal muscle approach plus single-segment laminectomy decompression via the dorsomedian approach is a good way due to limited invasion, less bleeding, simple operation, excellent reduction, reliable fixation and rapid recovery.

关 键 词：脊柱骨折 骨折固定术 内 骨钉 椎旁肌入路 正中入路 

分 类 号：R651.2[医药卫生—外科学]