单一后路减压联合前-中柱重建治疗严重胸腰椎爆裂性骨折

摘要

目的 探讨单一后路减压联合前-中柱重建治疗严重胸腰椎爆裂性骨折的临床效果.方法 对29例胸腰椎爆裂性骨折患者进行回顾性分析,所有患者经单一后路手术进行减压、复位并行椎体前-中柱支撑重建.采用美国脊髓损伤学会评分来评判患者的神经功能状态.通过术前、术后1周、术后1个月及末次随访时的X线片测量患者的椎间高度及后凸Cobb角,以此来评估骨折复位及脊柱前-中柱的重建及维持情况.结果 术中无重要血管以及医源性神经损害发生,亦无死亡病例.术后有2例合并腰背部皮肤挫伤的患者并发切口浅表感染,经扩创换药后愈合.患者术后神经功能除了6例A级的无恢复外,其他患者均较术前有不同程度的改善.患者术前、术后1周、术后1个月以及末次随访时的椎间高度分别为33.6、57.9、56.2、54.8 mm;后凸Cobb角分别为20.1°、4.3°、4.6°、5.1°.患者术后的椎间高度及后凸Cobb角均较术前有明显改善(P<0.01);术后1周、术后1个月、末次随访时的椎间高度及后凸Cobb角之间差异无统计学意义.结论 单一后路减压联合前-中柱重建治疗严重胸腰椎爆裂性骨折可以有效恢复和维持椎体间的高度,重建脊柱的稳定性,是一种安全有效的手术方式.%Objective To explore the curative effect of decompression combined reconstruction anterior-center columns of spine through single posterior approach for the treatment of severe thoracolumbar burst fracture.Methods The data of 29 patients with severe thoracolumbar burst fractures were retrospective studied.All patients underwent decompression combined reconstruction anterior-center columns of spine through single posterior approach.Results Neurological status of spinal cord at pre-operation, 1 week and 1 month post-operation and final follow-up were reviewed by America spinal injury association(ASIA) scoring system respectively.The intervertebral height and kyphosis Cobb angle were measured on the lateral X-ray films.There was no important blood vessel or nerve injury, no death case in this study.Incision infection in 2 cases, cured through debridement.The neuronal function of all patients was recovered at different degrees in final follow-up except 6 patients with grade A of ASIA.The average intervertebral height pre-operation, 1 week and 1 month post-operation, final follow-up was 33.6, 57.9, 56.2 and 54.8 mm respectively.The average kyphosis Cobb angle was 20.1°, 4.3°, 4.6°, 5.1°respectively.Both the intervertebral height and kyphosis Cobb angle were significantly improved at post-operation compared with pre-operation(P<0.01).However, there was no statistically significant differences at 1 week and 1 month post-operation, final follow-up in intervertebral height and kyphosis Cobb angle.Conclusion Treatment by decompression combined reconstruction anterior-center columns of spine through single posterior approach can restore and maintain the intervertebral height, reconstruct stability of spine, which is a safe and practical method for severe thoracolumbar burst fracture.