前后路手术治疗胸腰段椎体爆裂骨折  

Anterior and posterior approaches surgery for treatment of thoracolumbar vertebral burst fracture

作　　者：魏明和 师玉谨 黄彧翰 喻鹏 郑秀凤 WEI Ming-he;SHI Yu-jin;HUANG Yu-han;YU Peng;ZHENG Xiu-feng(Dept of Orthopaedics,Haicang Hospital of Xiamen City,Xiamen,Fujian 361026,China)

机构地区：[1]厦门市海沧医院骨科

出　　处：《临床骨科杂志》2020年第1期9-11,15,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨前后路手术治疗胸腰段椎体爆裂骨折的疗效。方法将37例胸腰段椎体爆裂骨折患者根据不同手术入路分为前路组(11例)和后路组(26例)。比较两组伤椎前缘高度百分比、后凸Cobb角、神经功能ASIA分级情况。结果患者均获得随访,时间12~36(15.0±3.7)个月。3例(均前路组)术中发现胸膜破裂;2例(均前路组)术后第2天复查X线及CT发现有胸腔积液;5例(前路组1例、后路组4例)脑脊液漏;2例(前、后路组各1例)植骨未融合,前路组1例人工椎体松动未融合,后路组1例术后12个月复查发现断钉,横突间植骨未融合。伤椎椎体前缘高度百分比、后凸Cobb角:两组术后1、12个月与术前比较均有明显改善(P<0.05),术后1个月与术后12个月比较差异无统计学意义(P>0.05),两组间比较差异无统计学意义(P>0.05)。神经功能ASIA分级:两组术后12个月与术前比较均有明显恢复(P<0.05)。结论治疗胸腰段椎体爆裂骨折应注重分析临床特点及影像学情况,选择恰当的手术入路,进行必要的减压,采用合适的植骨方法,能够取得理想的疗效。Objective To investigate the effect of anterior and posterior approaches surgery for thoracolumbar burst fracture.Methods The 37 patients with thoracolumbar burst fracture were divided into anterior approach group(11 cases)and posterior approach group(26 cases)according to different surgical approaches.The percentages of anterior edge height of injuried vertebrae,Cobb angle of kyphosis and ASIA classification of nerve function were compared between the two groups.Results All patients were followed up for 12~36(15.0±3.7)months.Pleural rupture was found in 3 cases(anterior approach group);pleural effusion was found in 2 cases(anterior approach group)by X-ray and CT examination on the 2nd day after operation;cerebrospinal fluid leakage occurred in 5 cases(1 case of anterior approach group,4 cases of posterior approach group);bone grafting was not fused in 2 cases(there was 1 case in each group,respectively),of which 1 case was due to artificial vertebral loosening in the anterior approach group,and screw breakage occurred in 1 case of the posterior approach group at postoperative 12 months examination,the bone graft between transverse processes was not fused.The percentages of anterior edge vertebral height and Cobb angle of kyphosis in the two groups were significantly improved at 1,12 months postoperation than those in the preoperation(P<0.05),there was statistical difference at 1,12 months after operation(P>0.05),without statistical difference between two groups(P>0.05).At 12 months after operation,the ASIA grading of nerve function in the two groups were significantly recovered than the preoperation(P<0.05).Conclusions In the treatment of thoracolumbar burst fracture,the analysis of clinical characteristics and imaging conditions should be focused to analyze,selecting the appropriate surgical approach,necessary decompression,and choosing the appropriate bone grafting method can achieve the desired effect.

关 键 词：胸腰段椎体爆裂骨折 前后路 植骨 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]