腰椎爆裂性骨折伴马尾神经硬膜疝的外科治疗及临床随访研究

Surgical treatment and clinical follow-up of lumbar burst fracture with cauda equina dural hernia

目的探讨腰椎爆裂性骨折伴马尾神经硬膜疝的外科治疗方法,通过临床随访评价其治疗效果及安全性.方法回顾性分析两家医院自2019年3月—2022年9月收治的24例腰椎爆裂性骨折伴马尾神经硬膜疝的患者均急诊行腰椎后路减压、钉棒系统内固定、椎板重建术,术后对患者进行美国脊柱损伤协会(ASIA)运动神经功能分级、腰椎前凸角、椎管侵占率、椎体前缘压缩率和骨折愈合情况等进行12个月的随访.进行测量、记录、统计学处理.结果经随访所有患者硬膜囊的撕裂均得到修复,马尾神经纤维的损伤得到不同程度的恢复,术后ASIA运动神经功能分级提高,骨折复位良好,平均骨折愈合时间为6.2个月.受伤椎体无明显塌陷,内固定良好,椎弓根钉无脱落及断钉情况.结论选择腰椎后路减压、钉棒固定、椎板重建术治疗腰椎爆裂性骨折伴马尾神经硬膜疝,术中切除破裂的椎板,采用长节段钉棒复位固定,修复撕裂的硬膜囊和损伤的马尾神经,同时使用人工椎板进行椎板重建,该手术采用单一入路解决了减压、复位、固定、重建、马尾神经及硬膜囊修复等问题,手术疗效确切,并发症较少,安全性较高,是一种较好的治疗选择.

Objective To explore the surgical treatment of lumbar burst fractures with cauda equina herniation,and to evaluate its therapeutic effect and safety through clinical follow-up.Methods A retrospective analysis was performed on 24 patients with lumbar burst fractures complicated by cauda equina herniation,who were admitted to two hospitals from March 2019 to September 2022.All patients underwent posterior lumbar decompression,screw-rod system internal fixation,and lamina reconstruction surgery.The patients were followed up for more than 12 months postoperatively,undergoing assessments of American Spinal Injury Association(ASIA)motor nerve function classification,lumbar lordosis angle,spinal canal invasion rate,anterior vertebral compression rate,and fracture healing status.Measurements,records,and statistical analyses were performed.Results After follow-up,the tear of the dural sac was repaired in all patients,and the injury of the cauda equina nerve fibers recovered to different degrees.The postoperative ASIA motor nerve function grade was improved and the fracture was restored well.The average fracture healing time was 6.2 months.The injured vertebral body showed no significant collapse,the internal fixation was good,and there was no loosening or breakage of pedicle screws.Conclusion The treatment of lumbar burst fractures with cauda equina herniation by posterior lumbar decompression,screw-rod fixation,and lamina reconstruction is effective.In this surgery,the ruptured lamina is removed,long-segment screw-rod reduction and fixation are used to repair the torn dural sac and injured cauda equina nerve.At the same time,artificial lamina is used for lamina reconstruction.This surgery uses a single approach to solve the problems of decompression,reduction,fixation,reconstruction,cauda equina and dural sac repair,with accurate surgical effects,fewer complications,and high safety.It is a better treatment choice.