前外侧入路侧前方减压在胸腰段爆裂骨折中的临床应用  

The clinical application of lateral extracavitary approach in the treatment of thoracolumbar burst fractures

作　　者：张官锋 侯庆先[1] 杨文玖[1] 刘成[1] 王志杰[1] 

机构地区：[1]青岛大学附属医院黄岛院区脊柱外科,266555

出　　处：《中华实验外科杂志》2017年第3期519-521,共3页Chinese Journal of Experimental Surgery

摘　　要：目的 探讨前外侧入路行减压植骨融合内固定术治疗胸腰段爆裂骨折伴有神经损伤患者的手术效果.方法 采用前外侧入路减压植骨融合内固定术治疗胸腰段（T11~L2）爆裂骨折伴有神经症状的患者22例.根据影像学资料,比较患者术前、术后及末次随访的Cobb角（°）、椎体前缘高度压缩百分比（%）、椎管占位率（%）.根据临床表现,比较患者术前、术后的美国脊髓损伤协会（ASIS）脊髓损伤水平评分,术后及末次随访的日本矫形外科学会（JOA）下腰痛评分改善率.结果 22例均获得（18.0±7.2）个月随访,Cobb角：术前（20.532±4.045）°、术后（5.936±1.081）°、末次随访（6.564±0.984）°,术后与术前比较差异有统计学意义（t=14.822,P=0.000）,末次随访与术前比较差异有统计意义（t=16.134,P=0.000）,末次随访与术后比较差异无统计学意义（t=-1.834,P=0.081）;椎体前缘压缩百分比：术前（51.182±7.670）%、术后（91.773±2.308）%、末次随访（90.545±4.284）%,术后与术前比较差异有统计学意义（t=-21.509,P=0.000）,末次随访与术前比较差异有统计学意义（t=-18.990,P=0.000）,末次随访与术后比较差异无统计学意义（t=1.528,P=0.141）;椎管占位率：术前（34.818±5.142）%、术后（3.155±0.578）%、末次随访（3.300±0.478）%,术后与术前比较差异有统计学意义（t=29.136,P=0.000）,末次随访与术前比较差异有统计学意义（t=28.304,P=0.000）,末次随访与术后比较差异无统计学意义（t=-1.560,P=0.134）.ASIS评分比较上2例完全性损伤患者无提高,12例患者获得1级提高,8例患者获得2级提高.JOA评分改善率上术后优良患者14例,末次随访优良患者19例,末次随访优良率（86.363%）与术后优良率（63.645%）比较明显提高.结论 通过前外侧入路进行侧前方减压植骨融合内固定术治疗伴有神经症状的胸腰段爆裂骨折能有效纠正后凸畸形,恢复�Objective To explore the outcome of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation operation for thoracolumbar burst fracture with nerve injury.Methods The clinical data of 22 patients with thoracolumbar （T11-L2） burst fracture with nerve injury of lateral extracavitary approach to anterior lateral decompression and bone fusion and internal fixation operation were analyzed.The radiographic data of cobb angle, vertebral height compression percentage and spinal canal encroachment rate were compared.All data were collected pre-operation, post-operation and at last follow-up.According to clinical manifestations, recovery of neurological function before and after operation assessed by the American Spinal Injury Association （ASIA） classification and improvement rate of Japanese Orthopaedic Association （JOA） score from post-operation to last follow-up were compared.Results All 22 cases were followed up after operation for （18.0±7.2） months.The Cobb angle in pre-operative was （20.532±4.045）°, in post-operation days was （5.936±1.081）°, in last follow-up was （6.564±0.984）°.The difference was statistically significant before and after operation （t=14.822, P=0.000）.Same difference at the last follow-up and preoperative comparison （t=16.134, P=0.000）.There was no significant difference between the last follow-up and postoperative （t=-1.834, P=0.081）.The percentage of vertebral height compression in pre-operative was （51.182±7.670）%, post-operation days was （91.773±2.308）%, in last follow-up was （90.545±4.284）%.At the post-operative, there was a significant difference compared with preoperative （t=-21.509, P=0.000）.Between the last follow-up and preoperative aiso a significant difference （t=-18.990, P=0.000）.No significant difference between the last follow-up and postoperative （t=1.528, P=0.141）.The spinal canal encroachment rate in Preoperative was （34.818±5.142）%, post-operation days was （

关 键 词：前外侧入路 侧前方减压术 胸腰段 爆裂骨折 

分 类 号：R687.3[医药卫生—骨科学]