前后联合入路治疗严重不稳定下腰椎爆裂骨折  

Combined anterior and posterior approaches to treat severely unstable lower lumbar burst fractures

作　　者：许建柱[1] 全仁夫[1] 谢尚举[1] 陈恩良[1] 赵士杰[1] 

机构地区：[1]杭州市萧山区中医院骨科,311201

出　　处：《中华创伤杂志》2017年第4期305-309,共5页Chinese Journal of Trauma

摘　　要：目的探讨前后联合入路治疗严重不稳定下腰椎爆裂骨折的临床疗效。方法采用回顾性病例系列研究分析2009年8月-2014年8月收治的14例下腰椎爆裂骨折患者临床资料，其中男12例，女2例；平均年龄39岁。损伤节段：L3 7例，L4 5例，L5 2例。合并后方韧带复合体（PLC）损伤9例。神经功能按美国脊髓损伤协会（ASIA）分级：B级2例，C级4例，D级5例，E级3例。均行后路椎弓根螺钉固定并前路椎管减压钛网或髂骨植骨融合术。比较治疗前后腰椎前凸角、椎体高度变化、椎管减压范围、神经功能ASIA分级，观察并发症情况。结果术后出现脑脊液漏2例，经局部加压处理2周后脑脊液漏停止。术后3例存在反复腰痛，于术后18个月拆除内固定后腰痛缓解。患者均获随访12～36个月，平均18个月。与术前比较，末次随访腰椎前凸角改善[（30．2±7．3）°：（41．3±6．5）°]，椎体前方高度丢失减小[（62．3±21．5）％：（11．8±7．8）％]，椎管前方占位减少[（65．7±30．5）％：（21．9±12．7）％]（P均〈0．05）。末次随访ASIA分级：C级1例，D级3例，E级10例，较术前明显改善（P〈0．05）。术后随访均未见明显植骨松动、假关节形成、内固定断裂或严重后凸畸形现象。结论前后联合入路治疗严重不稳定下腰椎爆裂骨折，可有效重建椎体高度及稳定性，恢复椎管容积，临床疗效满意。Objective To evaluate the efficacy of combined anterior and posterior approaches in treatment of severely unstable lower lumbar burst fractures. Methods A retrospective case series study was made on clinical data of 14 patients with lower lumbar burst fractures collected from August 2009 to August 2014. There were 12 males and 2 females, with a mean age of 39 years. Seven fractures occurred at L3, five at L4, and two at L5. Nine patients were associated with injury to the posterior ligament complex （PLC）. According to the American Spinal Injury Association （ASIA） classification, the spinal injuries were rated as grade B in two patients, grade C in four, grade D in five and grade E in three. All patients underwent posterior pedicle screw fixation combined with anterior spinal canal decompression and titanium mesh or iliac bone grafting. Lumbar lordosis angle, vertebral height, spinal canal decompression, ASIA grade and complications were evaluated after operation. Results Two patients experienced cerebrospinal fluid leakage postoperatively, which were healed after 2 weeks＇ local pressure treatment. Three patients experienced recurrent lumbar pain postoperatively, which were relieved after the removal of internal fixation 18 months after operation. All patients were followed up for 12-36 months （mean, 18 months）. Compared to the detection before operation, final follow-up showed improved lumbar lordosis [ （ 30.2 ±7.3 ） ° vs. （41.3 ± 6.5 ） ° ] , decreased loss of the anterior vertebral height [ （62.3 ± 21.5） % vs. （ 11.8 ± 7.8） % ] and reduced canal compromise [ （65.7 ±30.5） % vs.（21.9±12. 7）%] （all P 〈 0.05）. ASIA grade was significantly improved at the final follow-up, including grade C in one patient, grade D in three and grade E in ten （ P 〈 0. 05 ）. Follow-up showed no apparent graft loosening, pseudarthrosis, implant breakage and severe k＇~phosis. Conclusion Combined anterior and posterior approaches to treat severely unstable lower lumbar burst fract

关 键 词：腰椎 脊柱骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]