单侧椎板开窗自制夯实器椎体后壁复位减压治疗椎管占位胸腰椎爆裂性骨折的临床研究  

Treatment of spinal canal occupying thoracolumbar burst fractures by unilateral fenestration posterior wall reduction and decompression with a self-made rammer

作　　者：王翔宇 曹林虎 谭伦[2] 林旭[2] 吴超[2] 胡海刚[2] 吴春宝[1] Wang Xiangyu;Cao Linhu;Tan Lun;Lin Xu;Wu Chao;Hu Haigang;Wu Chunbao(Department of Spine Center,Chongqing Orthopaedics Hospital of Traditional Chinese Medicine,Chongqing400010,China;Department of Orthopaedics,the Fourth People’s Hospital of Zigong,Zigong,Sichuan Province643000,China)

机构地区：[1]重庆市中医骨科医院脊柱中心,重庆400010 [2]自贡市第四人民医院脊柱与创伤外科,四川自贡643000

出　　处：《创伤外科杂志》2024年第2期130-137,共8页Journal of Traumatic Surgery

基　　金：重庆市医学科研项目(卫生健康委员会和科技局联合,2020FYYX209);四川省重点科技计划项目(2016JY0108)。

摘　　要：目的探讨单侧椎板开窗自制夯实器椎体后壁复位减压治疗椎管占位胸腰椎爆裂性骨折(TLBF)的安全性和有效性。方法前瞻性研究2016年12月—2018年12月重庆市中医骨科医院和自贡市第四人民医院收治TLBF患者67例,男性48例,女性19例;年龄19~63岁,平均41.1岁。根据椎管减压方式不同分为实验组(33例)和对照组(34例)。实验组采用后正中入路单侧椎板有限开窗、自制夯实器对椎体后壁骨折进行夯实复位减压内固定融合术,对照组采用后正中入路全椎板切除减压复位内固定融合术。实验组男性23例,女性10例;年龄22~63岁,平均40.9岁;道路交通伤13例,高处坠落伤18例,其他2例;脊髓损伤Frankel分级:C级13例、D级12例、E级8例。对照组男性25例,女性9例;年龄19~59岁,平均41.2岁;道路交通伤12例,高处坠落伤19例,其他3例;脊髓损伤Frankel分级:C级12例、D级13例、E级9例。比较两组患者手术时间、术中出血量,术前、术后1周及末次随访伤椎前缘压缩比、伤椎Cobb角、椎管矢状径比值,术前和末次随访脊髓神经功能Frankel分级,并随访观察内固定相关并发症。结果实验组术中出血量少于对照组[(163.3±44.6)mL vs.(229.4±53.0)mL,P<0.001]。实验组术前较术后1周、末次随访伤椎前缘压缩比小[(51.8±10.1)%vs.(90.0±3.4)%vs.(88.8±3.5)%]、伤椎Cobb角大[(20.7±2.8)°vs.(3.4±1.5)°vs.(3.8±1.8)°]、椎管矢状径比值小[(43.4±9.5)%vs.(91.8±2.9)%vs.(93.3±4.7)%],术前较末次随访脊髓神经功能Frankel分级差[(C级13、D级12、E级8)vs.(C级3、D级5、E级25)],差异均有统计学意义(P<0.05);对照组术前较术后1周、末次随访伤椎前缘压缩比小[(51.4±9.3)%vs.(88.8±3.0)%、(51.4±9.3)%vs.(87.4±3.4)%]、伤椎Cobb角大[(21.7±3.6)°vs.(3.9±1.8)°vs.(4.0±2.0)°]、椎管矢状径比值小[(43.2±8.6)%vs.(91.5±2.7)%vs.(92.6±4.2)%],术前较末次随访脊髓神经功能Frankel分级差[(C级12、D级13、E级9)vs.(C级4、D�Objective To investigate the safety and effectiveness of unilateral fenestration posterior wall reduction and decompression with a self-made rammer in the treatment of spinal canal occupying thoracolumbar burst fractures(TLBF).Methods From Dec.2016 to Dec.2018,67 patients with TLBF admitted to Chongqing Orthopaedics Hospital of Traditional Chinese Medicine or the Fourth People’s Hospital of Zigong,Sichuan Province were enrolled in this prospective study.There were 48 males and 19 females aged 19-63(mean 41.1)years.Patients were divided into test group(n=33)and control group(n=34)according to the decompression methods.For the test group,patients were treated by posterior midline approach unilateral fenestration posterior wall reduction and de-compression,and subsequent consolidation with a self-made rammer;while for the control group,patients were trea-ted with posterior midline approach total laminectomy decompression reduction and internal fixation&fusion.In the test group,there were 23 males and 10 females aged 22-63(mean 40.9)years,with 13 road traffic injuries,18 falls from height and 2 others.Frankel's grading system showed 13 cases in grade C,12 in grade D and 8 in grade E.In the control group,there were 25 males and 9 females aged 19-59(mean 41.2)years,with 12 road traffic injuries,19 falls from height and 3 others.Frankel’s grading system showed 12 cases in grade C,13 in grade D and 9 in grade E.The two groups were comparable in terms of injury severity(compression ratio and Cobb angle of the injured ver-tebrae,sagittal diameter ratio of the spinal canal and spinal nerve function by the Frankel’s grading system before operation).The operation time,intraoperative blood loss,compression ratio and Cobb angle of the injured vertebrae and sagittal diameter ratio of the spinal canal at 1 week after operation and last follow-up,internal fixation-related complications,as well as the spinal nerve function by the Frankel's grading system at last follow-up were recorded and compared between the two groups.Resu

关 键 词：胸腰椎爆裂性骨折 后路 开窗减压 椎体后壁骨折 夯实器 

分 类 号：R687.3[医药卫生—骨科学]