摘要
目的探讨Ⅰ期后路椎弓根螺钉固定、360°椎管减压并重建治疗严重胸腰椎爆裂性骨折的安全性和有效性。方法2008年9月-2009年6月采用Ⅰ期后路椎弓根螺钉系统复位固定、360°椎管减压并重建方法治疗严重胸腰椎爆裂性骨折11例，其中男8例，女3例；年龄19～59岁，平均34．4岁。致伤部位：T12 1例，L1 3例，L2 2例，T3 3例，L4 2例。按AO分型均为A3．3型骨折。根据McCormack载荷评分法评分为7～9分，平均8．2分。脊髓神经损伤按Frankel分级：A级1例，B级1例，C级5例，D级4例。结果本组手术时间3．5～4．5h，平均4．1h；术中出血900—2800ml，平均1750ml；输异体血400—1200ml，平均760ml。术中、术后未出现手术相关并发症。椎体前柱高度术前丢失48％～85％（平均64．2％），术后恢复至正常的95％-100％（平均98．6％），后凸Cobb角由术前的-12°～35°（平均12．1°）恢复至术后-30°～7°（平均-8．1°），椎管占位由术前的82％～98％（平均89．5％）恢复至术后0—14％（平均2．2％），其中9例椎管获得彻底减压，2例椎管侧方仍有小的骨块残留。本组患者随访时间10～18个月，平均14．5个月。钛网前方及钛网内植骨于术后6个月均获得融合，椎管表面植骨层完全融合，椎管完整性良好。最后随访时伤椎前柱高度及后凸Cobb角得到有效的维持，未出现椎弓根螺钉系统松动、断裂或钛网移位等。脊髓神经功能除1例A级无变化外，其余均有Ⅰ～Ⅲ级的恢复。腰背部无疼痛10例，遗留轻度腰背部酸痛1例。结论I期后路椎弓根螺钉固定、360°椎管减压并重建是治疗严重胸腰椎爆裂性骨折的较好选择，但应严格把握手术适应证。
Objective To investigate safety and efficacy of one-stage pedicle screw fixation plus 360° spinal canal decompression and reconstruction in treatment of severe thoracolumbar burst fractures. Methods The study reviewed 11 patients （8 males and 3 females, at age range of 19-59 years, mean 34.4 years） with severe thoracolumbar burst fracture, who underwent one-stage posterior pediele screw fixation, 360° spinal canal decompression and reconstruction. The injury location was at T12 in one patient, at L1 in three, at L2 in two, at L3 in three and at L4 in two. According to AO classification, all patients were with type A 3.3 fractures. McCormack load score was 7-9 points （average 8.2 points）. Based on the Frankel＇ s scale, the spinal cord function was classified as grade A in one patient, grade B in one, grade C in five and grade D in four. Results All the operations accomplished successfully, with operation duration for 3.5-4.5 hours （mean 4.1 hours） , blood loss for 900-2 800 ml （mean 1 750 ml） and allogeneic blood transfusion for 400-1 200 ml （average 760 ml）. There was no complication either during or after operation. The loss rate of the anterior vertebrae column height was 48% -85% （ average 64.2% ） before operation and recovered to 95% -100% （average 98.6% ） of the normal. The kyphotic Cobb angle was at -12°-35° （ average 12.1 ° ） before operation and recovered to - 30°-7° （ average - 8.1 ° ） after operation. The spinal canal stenosis rate was improved remarkably. The patients were followed up for 10-18 months （average 14.5 months） , which showed solid bone fusion, with no implant failure. The spinal cord function was improved Ⅰ to Ⅲ degrees in all patients except for one patient at grade A. One patient had mild lower back pain. Conclnsions One-stage pediele screw fixation plus 360° spinal canal decompression and reconstruction is a good alternative for severe thoracolumbar burst fracture, but it is essential for choosing strictly the surgical indications.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2011年第8期679-683,共5页
Chinese Journal of Trauma
基金
浙江省嘉兴市科技计划资助项目（2010AY1056）
关键词
脊柱骨折
胸椎
腰椎
骨折固定术
内
椎弓根螺钉
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Fracture fixation, internal
Pedicle screws
