后路经侧前方椎管减压结合伤椎置钉短节段固定治疗严重胸腰椎爆裂骨折合并脊髓损伤  

Curative effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury

作　　者：高杰 竺得洲 王浩 李连华 刘智 孙天胜 GAO Jie;ZHU De-zhou;WANG Hao;LI Lian-hua;LIU Zhi;SUN Tian-sheng(Department of Orthopaedics,the Seventh Medical Center of PLA General Hospital,Beijing100700,China)

机构地区：[1]中国人民解放军总医院第七医学中心骨科,北京100700

出　　处：《中国骨伤》2020年第12期1128-1133,共6页China Journal of Orthopaedics and Traumatology

基　　金：军队医学科技计划创新工程专项(编号:16CXZ002);北京市科技新星计划(编号:Z181100006218031)。

摘　　要：目的:探讨后路经侧前方椎管减压结合伤椎置钉短节段固定治疗严重胸腰椎爆裂骨折并脊髓损伤的临床疗效。方法:回顾性分析2016年1月至2018年6月收治的16例严重胸腰椎爆裂骨折(椎管侵占率>50%、椎体后缘存在翻转骨块)合并脊髓损伤的患者,其中男10例,女6例;年龄19~57岁。高处坠落伤8例,车祸伤6例,其他伤2例。骨折部位:T114例,T125例,L15例,L22例。所有患者采用后路经侧前方椎管减压结合伤椎置钉短节段固定的手术方式,通过测量伤椎前缘丢失高度、伤椎邻近节段Cobb角、椎管侵占率评价影像学效果,并通过Frankel脊髓损伤评级和视觉模拟评分(visual analogue scale,VAS)评价临床疗效。结果:16例均获得完整随访,随访时间11~28(15.9±5.4)个月。手术时间(234±41)min,术中出血量(431±93)ml。伤椎前缘高度丢失术前(52.25±10.10)%,术后3 d(8.93±3.61)%,末次随访(9.25±2.88)%;术后3 d、末次随访时较术前恢复(P<0.01),末次随访时较术后3 d无明显变化(P>0.05)。伤椎邻近节段Cobb角术前(28.19±10.89)°,术后3 d(5.31±5.14)°,末次随访(6.81±4.59)°;椎管侵占率术前(67.68±12.45)%,术后3 d(7.69±4.46)%,末次随访(4.75±1.63)%,术后3 d、末次随访时较术前恢复(P<0.01),末次随访时较术后3 d也有一定程度恢复(P<0.05)。末次随访时12例脊髓神经功能获得改善,4例未获得改善,未出现神经功能恶化者;VSA评分由术前的(7.8±0.9)分改善至末次随访的(1.8±0.7)分。结论:对于椎管侵占率>50%、椎体后缘存在翻转骨块的严重胸腰椎爆裂骨折合并脊髓损伤时,后路经侧前方椎管减压结合伤椎置钉短节段固定具有复位精确、减压彻底、固定牢固等特点。Objective:To explore the effect of anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach for severe thoracolumbar burst fractures with spinal cord injury.Methods:From January 2016 to June 2018,16 patients with severe thoracolumbar burst fractures(more than 50%of ratio of spinal canal encroachment,reverse fragment at the posterior edge of the vertebral body)with spinal cord injury were retrospectively analyzed,including 10 males and 6 females,ranging in age from 19 to 57 years old.Causes of injury:8 cases of fall injury,6 cases of traffic accident injury and 2 cases of other injuries.Fracture site:T11 in 4 cases,T12 in 5 cases,L1 in 5 cases,L2 in 2 cases.All the patients underwent anterolateral spinal canal decompression combined with short segment screw fixation with posterior approach.The curative imaging effects were evaluated by measuring the loss height of the anterior edge of the injured vertebra,Cobb angle of the adjacent segment of the injured vertebra,and ratio of spinal canal encroachment.The clinical effects were evaluated by Frankel spinal cord injury rating and visual analogue scale(VAS).Results:All 16 patients were followed up,and the average follow-up time was(15.9±5.4)months.The average operation time was(234±41)minutes and the average amount of bleeding was(431±93)ml.The loss of anterior height of injured vertebrae was(52.25±10.10)%before operation,(8.93±3.61)%at 3 days after operation,and(9.25±2.88)%at the latest follow-up.The results of 3 days after operation and the latest follow-up were better than that before operation,and there was no significant differences between results at the latest follow-up and 3 days after operation(P<0.01).Cobb angle of adjacent segment of injured vertebrae was(28.19±10.89)°before operation,(5.31±5.14)°3 days after operation,and(6.81±4.59)°at the latest follow-up.The ratio of spinal canal encroachment was(67.68±12.45)%before operation,(7.69±4.46)%at 3 days after operation,and(4.75±1.63)%at the late

关 键 词：胸椎 腰椎 骨折 脊髓损伤 

分 类 号：R684[医药卫生—骨科学]