摘要
目的观察后路复位结合“H”形植骨及棘突回植重建椎管结构治疗胸腰椎骨折的临床疗效。方法回顾性分析2008年2月-2012年6月手术治疗的胸腰椎爆裂性骨折患者43例，其中男30例，女13例；年龄23—55岁，平均38岁。致伤原因：高处坠落伤21例，交通伤16例，重物砸伤6例。椎体骨折采用Denis进行分类，Frankel脊髓损伤分级评估神经损伤及恢复程度。对43例患者采用后路复位结合“H”形植骨及棘突回植重建椎管结构术式进行治疗。采用视觉模拟评分（visual anasogue scale，VAS）评估术后症状改善情况，测量Cobb角的变化及椎管矢状径改变，并分析治疗效果。结果43例均获得随访12～46个月，平均24个月。患者术后疼痛明显缓解。术后Cobb角（8．23°）较术前（43．56°）明显改善（t=1．33，P〈0．01）。CT检查显示，术前伤椎椎管狭窄率平均为56．3％，随访时（〉12个月）伤椎椎管矢状径平均值大于相邻节段矢状径平均值，伤椎椎管矢状径与相邻节段矢状径平均值比率为111．3％-120．3％，平均116．3％，椎管狭窄率每1例均为负值；并显示椎管后部所植骨全部生长愈合，椎管结构得到良好重建。Frankel脊髓损伤分级均有不同程度的恢复。结论经后路复位结合“H”形植骨及棘突回植不仅能使骨折得到良好复位、脊柱后部椎管结构得到有效重建，亦可有效避免医源性椎管狭窄，值得临床推广应用。
Objective To detect the clinical effect of posterior reduction combined with Hshaped bone grafting and spinous process replantation for reconstruction of spinal structures in treatment of thoracolumbar fracture. Methods Forty-three patients with thoracolumbar burst fracture treated surgically from February 2008 to June 2012 were reviewed retrospectively. There were 30 male and 13 female patients aged 23 to 55 years （mean, 38 years）. Fracture resulted from high falls in 21 patients, traffic accidents in 16 patients, and a crush by heavy objects in 6 patients. Denis system was used for classification of fracture and Frankel rating for assessing the degree of nerve damage and recovery. After posterior reduction combined with H-shaped bone grafting and spinous process replantation for all patients, visual analogue scale （VAS） was utilized to assess symptom improvement and Cobb＇s angle and sagittal spinal canal diameter were measured to help assess the treatment outcome. Results Pain was apparently eased at a 24-month follow-up （ range, 12-46 months）. Cobb＇ s angle improved from preoperative 43.56° to postoperative 8.23° （ t = 1.33, P 〈 0.01 ）. CT findings showed mean spinal canal stenosis rate was 56. 3% before surgery and that mean sagittal canal diameter of the injured spine was larger than that of adjacent segments at follow-up, with the mean ratio of 116.3% （ range, 111.3%-120.3qc ）. Rate of spinal canal stenosis was negative for all patients and posterior canal with bone grafts healed. Spinal cord injury improved at least one Frankel grade. Conclusion Posterior reduction combined with H-shaped bone grafting and spinous process replantation is worthy of clinical application, for the procedure can restore the fractured thoracolumbar spine and posterior canal structure, but also effectively avoid the iatrogenic spinal stenosis.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2014年第6期530-534,共5页
Chinese Journal of Trauma
关键词
脊柱骨折
胸椎
腰椎
椎管
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Spinal canal
