摘要
目的：探讨半椎板切除减压、撬拨复位伤椎体内植骨治疗严重胸腰椎爆裂骨折的临床疗效。方法：对32例严重胸腰椎爆裂骨折行椎弓根螺钉内固定、半椎板切除减压、撬拨复位伤椎体内植骨治疗。采用Frankel神经功能分级评价术后神经功能恢复情况评价脊髓及马尾神经功能改善情况。通过手术前后摄X线片测量骨折椎体相对高度、Cobb角及CT测量椎管内骨折块占位率情况评价骨折愈合及椎管减压情况。结果：手术时间120~190 min,平均150.4 min;术中出血量200~500 m L,平均340 m L;术后1年伤椎体水平椎管狭窄率明显降低,狭窄程度明显减轻（P〈0.01）;术后各时间点Cobb角与术前比较均明显恢复（P〈0.01）;术后各时间点椎体相对高度与术前比较均明显提高（P〈0.01）;30例患者的术后1年Frankel神经功能分级有1~3级改善。结论：半椎板切除减压、撬拨复位伤椎体内植骨治疗严重胸腰椎爆裂骨折临床疗效满意,椎管得到充分减压,椎体内植骨重塑了椎体的形状和高度,伤椎愈合、植骨融合良好,取出内固定后矫正度无明显丢失,是治疗严重胸腰椎爆裂骨折的有效方式。
Objective：To investigate the therapeutic effect of severe thoracolumbar burst fractures by lateral laminectomy decompression, prying and bone grafting in injured vertebral body. Methods：32 patients with severe thoracolumbar burst fractures were treated by posterior short - segment fixation combined with lateral laminectomy decompression, prying and bone grafting in injured vertebral body. Accorded X - ray film was taken to measure the relative height of fractured vertebrae for evaluating vertebral height restoration. Cobb angle evaluated correction of kyphosis;and Frankel classification was conducted to evaluate the function recovery of the spinal cord. Results：The average surgery time was 150.4 min （ 120 - 190 min） and the average blood loos was 340 mL（200 -500 mL）. 1 year after operation, showed the space occuping rates of fractureed vertebrae had much better than that before operation （P 〈 0. 01 ）. The Cobb angles were much better than that before operation （P 〈 0. 01 ）. The relative height of fractured vertebrae were much better than that before （ P 〈 0. 01 ）. 30 cases was improved 1 - 3 grades in neural function. Conclusion：Treatment of severe thoracolumbar burst fractures by lateral laminectomy decompression, prying and bone grafting in injured vertebral body has satisfactory effectiveness, which can reconstruct vertebral body shape and height with spinal cord decompression. Bone graft healing and bony fusion are much better too.
出处
《现代临床医学》
2015年第3期211-213,共3页
Journal of Modern Clinical Medicine
关键词
严重胸腰段骨折
椎管减压
伤椎体内植骨
内固定
severe thoracolumbar burst fractures
spinal cord decompression
bone grafting by unilateral spinal canal
internal fixation
