摘要
目的探讨重度腰椎爆裂骨折伴马尾神经硬膜疝患者的手术时机及在传统的单纯复位减压基础上行马尾神经及硬膜囊修复后的临床疗效。方法自2009-01—2012-12诊治54例单节段重度腰椎爆裂骨折伴马尾神经硬膜疝患者,回顾性研究在传统后方入路行椎管扩大神经减压、后凸畸形的复位,在腰椎稳定性重建的基础上扩大硬膜囊破裂口,清除硬膜囊内血肿后同时完成马尾神经及硬膜囊的修复,术后对其神经恢复情况进行评估随访。结果所有患者的内固定牢靠,马尾神经纤维及硬膜囊的损伤全部得到不同程度的修复,没有并发症的出现,术后神经功能评定按ASIA分级评价,提高了1-3级。结论对于重度腰椎体爆裂骨折合并椎板骨折,应注意马尾神经硬膜疝存在的可能,术中修复硬膜囊的裂伤和损伤的马尾纤维,防止神经损伤加重及预防脑脊液漏。在传统后方入路的基础上打开硬膜囊从而实现对神经及硬膜囊的修补,兼顾了减压、复位、稳定性重建及马尾神经及硬膜囊修复,同时降低脑脊液漏导致感染的风险,疗效确切。
Objective To investigate the operation timing for severe lumbar burst fracture withcauda equina dural hernia and the clinical curative effect in the simple reduction based on traditional decompression of the cauda equina and dural repair after fracture. Methods From January 2009 to December 2012, a total of 54 cases of single segment of severe lumbar burst fracture with cauda equina dural hernia were treated. A retrospective study was conducted for the following procedure：traditional posterior vertebral canal expanded neural decompression, reduction and kyphosis, lumbar spine stability reconstruction based on the expansion of the hard membrane vesicles rupture, removal of the dural sac at the same time to complete the repair of hematoma after cauda equina and dural sac. The postoperative neurological recovery was followed up and evaluated. Results In all the patients internal fixation was solid and reliable, and cauda equina nerve fibers and the dura were repaired in different degree. No complications occurred. According to ASIA classification, nerve function after operation increased by 1-3 level. Conclusion For severe lumbar burst fracture with vertebral fracture patients, we should pay attention to existence of cauda equinadural hernia. During the repair of dural sac rupture and damage of cauda equina fibers, nerve injury and cerebrospinal fluid leakage should be prevented. The dural sac should be opened based on traditional posterior approach to the neural and dural repair, which can achieve decompression, reduction, stability reconstruction and cauda equina and dural repair of cerebrospinal fluid leakage, reduce infection risk, with curative effect.
出处
《中国骨与关节损伤杂志》
2015年第1期72-74,共3页
Chinese Journal of Bone and Joint Injury
关键词
腰椎
爆裂骨折
硬脊膜破裂
马尾神经
Lumbar vertebrae
Burst fracture
Spinal dural rupture
Cauda equina
