Objective To investigate the clinical efficacy of using one-stage posterior subtotal corpectomy and three-column reconstruction for treatment of severe thoracolumbar fractures and dislocation. Methods The 22 patients with severe thoracolumbar fractures and dislocation underwent one-stage subtotal vertebrectomy, titanium mesh implanta-tion and pedicle screw fixation through posterior approach. General information such as operation time, intraoperative blood loss, and complications of the patients were documented. The ASIA scale was used to assess each patient's neu-rological function after the operation. X-ray and CT examination were used to evaluate Cobb's angle, encroachment of the spinal canal, and bone graft fusion. Results Patients had surgical duration of 180～310(211.82±36.09)min, intraoperative blood loss was ＞1 500 ml in 5 cases, 1 000～1 500 ml in 15 cases, ＜1 000 ml in 2 cases. All pa-tients got 12～36 months follow-up. Complications:2 patients were with cerebrospinal fluid leakage, 2 patients with transient nerve root injury, and 6 patients with titanium mesh tilt. At last follow-up, ASIA grade A of 9 patients showed no recovery; 7 of 10 grade B patients improved to grade C, 2 to grade D, and 1 had no recovery; 2 of 3 grade C patients improved to grade D, 1 to grade E. Cobb's angle:the preoperative was 23.95°± 3.86°, which decreased to 6.41°± 1.22°at the postoperative 1 week, correction degree of 17.76°±5.73°;compared with the preoperative, there was statistical significance(P＜0.05). The Cobb's angle was 7.23°±1.78° in the final follow-up,correction degree was 0.91°±1.36°,compared with the postoperative 1 week,there was statistical significance(P＞0.05), In addition, preoperative Wolter scale scores of 1～3 (1.91±0.70) decreased to 0 after the surgery. All cases got one-stage wound healing, without loosening or fracture of internal fixation. Conclusions One-stage posterior subtotal corpectomy with titanium mesh implants is a surgical procedure to treat severe thoracolumbar fractures,which is char-acterized by less trauma, complete decompression, and rapid establishment of three-column stability. Moreover, this operation can decrease the occurrence of posttraumatic thoracolumbar kyphosis. Hence, it is an effective treatment for severe thoracolumbar fractures.%目的 探讨后路伤椎次全切除三柱重建治疗严重胸腰椎骨折脱位的恢复情况疗效.方法 采用一期后路伤椎次全切除、钛网植骨支撑、椎管减压、椎弓根螺钉固定治疗22例严重胸腰椎骨折脱位患者.记录手术时间、术中出血量及并发症情况;采用ASIA分级评价患者术后神经功能恢复情况;通过X线和CT检查评估术后Cobb 角、椎管占位及植骨融合情况.结果 手术时间180～310(211.82±36.09) min;术中出血量:＞1 500 ml 5例,1 000～1 500 ml 15例,＜1 000 ml 2例. 22例均获得随访,时间12～36个月.并发症:脑脊液漏2例,一过性神经根损伤2例,钛网倾斜6例.末次随访ASIA分级: A 级9 例无恢复;B 级10 例恢复至C级7 例、D级2 例,1 例无恢复;C级3 例恢复至D级2 例、E级1 例. Cobb角:术前为23.95°±3.86°,术后1周为6.41°±1.22°,矫正度为17.76°±5.73°,与术前比较差异有统计学意义(P ＜0.05).末次随访时为7.23°±1.78°,角度丢失为0.91°±1.36°,与术后1周比较差异无统计学意义(P＞0.05). Wolter指数:术前为1～3(1.91±0.70),术后为0.患者植骨均顺利融合,内固定无松动、断裂.结论 一期后路椎体次全切除钛网置入技术治疗严重胸腰椎骨折具有创伤小、减压彻底、可即刻建立三柱稳定等优点,并可减少晚期胸腰椎后凸畸形发生,是治疗严重胸腰椎骨折的一种有效术式.
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