胸腰椎爆裂骨折前路重建手术的疗效观察  

Anterior reconstruction operation of thoracolumbar burst fractures

作　　者：马立泰[1] 刘浩[1] 龚全[1] 李涛[1] 宋跃明[1] 刘立岷[1] Ma Litai;Liu Hao;Gong Quan;Li Tao;Song Yueming;Liu Limin(Department of Orthopedics, West China Hospital, Sichuan University, Chengdu 600041, China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《骨科临床与研究杂志》2020年第4期208-213,242,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的观察胸腰椎爆裂骨折前路重建手术的疗效。方法回顾分析2018年1月至2019年10月四川大学华西医院骨科胸腰椎前路手术并获得随访的患者69例;其中男44例,女25例;年龄22.17~64.75岁。损伤类型包括车祸14例、滑倒摔伤2例、重物砸伤5例、高处坠落48例。骨折椎体节段包括T12-L4分别为3、35、16、10、5例;骨折椎体AO分型包括A型67例、B型2例;脊髓神经损伤Frankel分级包括A级2例、B级4例、C级8例、D级20例、E级35例。手术采用单纯后上角骨折块和椎体上缘部分切除单节段重建11例,伤椎椎体切除短节段重建58例。记录手术持续时间、术中出血量、术中输血量、术后引流量,影像学测量指标包括伤椎后凸角以及术前术后随访骨折节段矢状面Cobb角、椎管内占位面积、伤椎及其上下邻近椎间盘的高度,术前术后伤椎及其上下各1个椎体(包括椎间盘)的高度。结果全部患者手术时间为(216.5±40.6)min;术中出血量为(612.3±406.4)ml;术中输血量(包括自体血回输)为(413.4±426.3)ml;术后引流量为(182.2±134.8)ml;伤椎后凸角为(21.5±6.6)°;术前短节段矢状面Cobb角为(9.0±9.6)°,术后为(2.0±9.1)°,随访时为(2.0±8.6)°,术前术后比较差异有统计学意义(P=0.003),随访时比术后增加不明显(P=0.977);椎管占位面积(0.54±0.14)×100%,有8例(11.6%)患者因技术原因没有减压彻底,术后为(0.04±0.10)×100%,差异有统计学意义(P=0.000),随访时没有明显增加。术前术后伤椎及其上下椎间盘的高度和术前术后随访伤椎及其上下各1个椎体(包括椎间盘)的高度术后较术前明显增高(P=0.000)。随访时绝大多数在术后3个月骨愈合,没有断钉断棒,神经功能较入院时平均提高0.89级。结论前路手术是治疗胸腰椎爆裂骨折的有效方法,对改善骨折节段后凸畸形和神经功能好,椎管内占位减压彻底、植骨融合率高,术中出血量、输血量可控,术后引流量少。Objective To evaluate the efficacy of thoracolumbar burst fracture treated by anterior approach reconstruction.Methods A retrospective study was conducted on 69 patients with thoracolumbar fractures underwent anterior approach surgery and were followed up from January 2018 to October 2019,including 44 males and 25 females and aged from 22.2 to 64.8 years.Injury causes included traffic accident in 14 cases,slipping and falling in 2,impact from heavy objects in 5 and falling from high places in 48.Fractures were located at T12 to L4 in 3,35,16,10 and 5 cases,respectively.According to Frankel grading for neurological status,2 cases were at grade A,4 at B,8 at C,20 at D,35 at E.Surgical methods were short segment reconstruction in 58 patients and single segment reconstruction that performed in 11 patients with posterior superior fracture block and upper margin of vertebral body collapse.Operative time(OT),intraoperative blood loss(IBL),intraoperative blood transfusion(IBT),postoperative drainage volume(PDV)were recorded.Radiographic measurements included involved vertebral kyphotic angulation(IVKA)and sagittal Cobb angle(SCA),intraspinal canal encroachment area(ICEA),height of involved vertebral and adjacent disc(HIVAD)and height of involved vertebral and adjacent vertebral body including the disc HIVAV preoperatively,postoperatively and follow-up.Results The OT was(216.5±40.6)minutes;the IBL was(612.3±406.4)ml;the IBT(including autogenous blood transfusion)was(413.41±426.3)ml.Average PDV of 69 patients was(182.2±134.8)ml.The IVKA of the injured vertebra was(21.5±6.6)°.The SCA of the short segment was(9.9±9.6)°preoperatively,(2.0±9.1)°postoperatively,and(2.0±8.6)°follow-up.The difference of postoperative SCA to preoperative was statistically significant(P=0.003).The preoperative ICEA was(0.54±0.14)×100%;the postoperative ICEA was(0.04±0.10)×100%;the follow-up ICEA(0.04±0.10)×100%(P=0.000).The postopertive HIVAD and HIVAV were significantly higher than that of preoperative,and the difference was stat

关 键 词：脊柱骨折 修复外科手术 胸椎 腰椎 

分 类 号：R68[医药卫生—骨科学]