经后路单侧开窗270°减压治疗伴神经损伤型胸腰椎爆裂性骨折的临床疗效分析  

Clinical analysis of 270 degree decompression after unilateral fenestration in the treatment of thoracolumbar burst fractures with nerve injury

作　　者：方磊 陈子华 刘丹 陈鑫营 周孝斌 FANG Lei;CHEN Zi-hua;LIU Dan;CHEN Xin-ying;ZHOU Xiao-bin(Department of Spinal Surgery,Heyuan People's Hospital,Heyuan,Guangdong 517000)

机构地区：[1]河源市人民医院脊柱外科,广东河源517000

出　　处：《赣南医学院学报》2019年第3期234-236,共3页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：河源市科技计划项目(编号:170524200220556)

摘　　要：目的:探讨经后路肌间隙入路单侧开窗椎管270°减压治疗伴神经损伤型胸腰椎爆裂性骨折的临床疗效。方法:回顾性分析28例伴神经损伤型胸腰椎爆裂性骨折患者的临床资料,本组患者均接受经肌间隙入路单侧开窗椎管270°减压治疗,比较手术治疗前以及手术治疗后3 d的伤椎高度、伤椎矢状位Cobb角、椎管内骨块占位率,并对患者的预后情况进行总结。结果:本组患者术后3 d的伤椎高度高于术前,伤椎矢状位Cobb角和椎管内骨块占位率低于术前,差异均有统计学意义(P <0. 05);通过6～18个月的随访,无死亡和神经症状加重患者,1例患者发生脑脊液漏,对症处理后得以痊愈,1例患者手术后3个月出现椎弓根螺钉松动,半年后予以拆除。结论:经后路肌间隙入路单侧开窗椎管270°减压可有效治疗伴神经损伤型胸腰椎爆裂性骨折,术后可使脊柱结构以及稳定性得到有效保留,同时可使椎管得到有效减压。Objective:To evaluate the clinical efficacy of 270-degree decompression of unilateral open window canal in the treatment of thoracolumbar burst fractures with posterior approach.Methods:The clinical data of 28 patients with thoracolumbar burst fractures with nerve injury were retrospectively analyzed.All patients underwent 270-degree decompression of unilateral fenestration through the intermuscular approach,compared with 3 days after surgery and 3 days after surgery.The height of the injured vertebrae,the sagittal Cobb angle of the injured vertebrae,the bone occupying rate of the spinal canal,and the prognosis of the patients were summarized.Results:The height of the injured vertebrae in this group was higher than that before operation.The Cobb angle of the sagittal plane and the bone occupying rate of the spinal canal were lower than those before operation,and the difference was statistically significant(P<0.05).At the follow-up of 6-18 months,there were no death and neurological symptoms in this group.One patient developed cerebrospinal fluid leakage and recovered after symptomatic treatment.One patient developed pedicle screw loosening 3 months after surgery and was removed after half a year.Conclusions:The 270-degree decompression of the unilateral open window canal can effectively treat the thoracolumbar burst fracture with nerve injury through the posterior approach.The postoperative structure and stability of the spine can be effectively preserved,and the spinal canal can be effectively effective stress reliever.

关 键 词：胸腰椎 骨折 神经损伤 开窗减压 疗效 

分 类 号：R683.2[医药卫生—骨科学]