后路经椎弓根环形减压三柱重建治疗胸腰椎骨折

摘要

O b jective To evaluate tie effect of circular decanpiession and three-column reconstruction of spine in the treatnentof fhoracolznbar vertebral fracture through a posterior transpedicular approach M ethods Twenty patients with thoracolumbar vertebral fractures were treated with broken-bone excision, circular decompression and three- column reconstruction of spine through a posterior transpedicular approach Twenty patients were followed up Neurological status was evaluated by ASIA, scoring systan X ray and CT results were exanined pre-operatively, atl week postoperatively and atl2 month postoperatively, which was used to compare the canal occupation and the Cobb angle, and to evaluate the decompression and reconstruction status Results All operations were finished successfully The average operation tine was2. 8 h, and the average hanorrhage was900ml There was no nerve and blood vessel injury and no infection and deep vein thrombosis All patients were perfomed recovery training atl week postoperatively The average follow-up was 18 months( ranging 12-24 months). Bone graft fusion was observed in all patients except one No looseness and rupture of internal fixation, no obvious bss of vertebral heigh| spinal radian and vertebral canal volume were observed Nervous function resulted in different degree of recovery in all patients except those who had the nervous function of grade A Conclusion The treatnentof thoraco-lumbar vertebral fractures by broken-bone excision, circular decompression and three-column reconstruction of spine through a posterior transpedicular approach is safe and useful in reconstructing vertebral heighf spinal canal volume and Cobb-angle This operation has the advantages of little trauma and quick recovery%目的 探讨后路经椎弓根环形减压三柱重建治疗胸腰段椎体骨折临床疗效.方法 对20例胸腰段椎体骨折采用后路经椎弓根椎管前方骨块切除、环形减压、三柱重建技术进行手术治疗,采用美国脊髓损伤协会(ASIA)分级进行神经功能评估,通过术前、术后1周及术后12个月随访时的X线及CT片,比较椎管侵占率及Cobb角变化,评估椎管减压及复位情况.结果 手术均顺利完成,平均手术时间2.8h,平均出血量900ml,术中无神经及血管进一步损伤,术后1周支具保护下坐起或离床活动,并行早期康复训练,无感染及深静脉血栓等并发症.术后随访12~24个月,平均18个月,随访患者除1例植骨融合欠佳外,其余随访患者植骨均顺利融合,内固定无松动、断裂,椎体高度、曲度和椎管容积无明显丢失.除ASIA分级为A级患者外,其他各级患者神经功能均有不同程度的恢复.结论 后路经椎弓根椎管前方骨块切除、环形减压、三柱重建治疗胸腰段椎体骨折可以有效恢复椎体高度、椎管容积及Cobb角度,是一种安全、有效的手术方法.