前路减压植骨融合及钛板固定治疗胸腰椎骨折合并脊髓损伤

Anterior decompression and bone graft with titanic plate fixation for thoracolumbar fractures with spinal cord injuries

目的观察前路减压、植骨融合及钛板固定治疗胸腰椎骨折合并脊髓损伤的临床疗效.方法1999年3月～2004年5月有68例胸腰椎骨折合并脊髓损伤的患者接受前路减压、结构性植骨及钛板固定治疗.本组男45例,女23例,年龄14～61岁,平均36.7岁.骨折节段:T11 1例、T12 20例、L1 33例、L212例,为L1,2 1例和L2,3 1例.神经功能情况:完全性截瘫10例,不全性截瘫58例.固定器材:Z-PLATE钛板43例,PROFILE钛板19例,ALPS钛板6例.植骨材料:自体髂骨块45例和充填自体碎骨的钛网23例.采用Frankel分级和ASIA评分评估神经功能恢复情况,通过影像学检查脊柱畸形角(Cobb角)的纠正、减压范围、骨块或钛网的位置及骨愈合情况.结果65例随访8～48个月(3例失访),平均15.6个月.61例术后神经功能均有不同程度的改善,平均提高了1.25级,ASIA评分明显提高.CT及MRI检查示椎管减压彻底.髂骨块和钛网均无松动、移位等变化.三种钛板均无松动、移位及断裂.所有随访病例脊柱畸形均获得良好矫正和骨性融合,无畸形矫正的丢失.结论胸腰椎骨折合并脊髓损伤行前路减压安全彻底,有利于神经功能恢复.钛板内固定和结构性植骨稳定性好,骨性愈合率高.

ObjectiveTo investigate the clinical effect of anterior decompression and bone graft with titanic plate fixation on thoracolumbar fractures with spinal cord injuries. MethodsSixty-eight cases of thoracolumbar fractures with spinal cord injuries were treated by anterior decompression and structural bone graft with titanic plate fixation from March 1999 to May 2004. There were 45 males and 23 females aged from 14 to 61 years with an average of 36.7 years. The fractures were located at T 11 in 1 case, T 12 in 20, L 1 in 33, L 2 in 12,L 1,2 in 1 and L 2,3 in 1. The states of preoperative neurological function were complete paraplegia in 10 cases and incomplete paraplegia in 58. The fixators were titanic Z-PLATE in 43 cases,PROFILE in 19 and ALPS in 6. The materials for bone graft were auto-ilium in 45 cases and titanic mesh filled with auto-bone fragments in 23. The recovery of neurological function was evaluated according to Frankel grades and ASIA scores. The correction on the angle of spinal deformity( Cobb angle ), the area of decompression, the position of bone mass or titanic mesh and bone fusion were all examined by images. ResultsAll of the 68 cases had successful operations. Sixty-five cases were followed up for 8-48 months( mean 15.6 months ). The postoperative neurological function was recovered partly or completely in 61 cases and improved by 1.25 Frankel grades on average. The postoperative ASIA scores in all cases rised evidently. The CT scans and MRI scans showed that the compression of spine cord was completely relieved. Both ilium and titanic mesh did not loose and shift. Three sorts of titanic plate did not loose,shift and rupture. The spinal deformities were well corrected without correction loss and implant failure at follow-up. The spinal fusion was excellent in all follow-up cases. ConclusionAnterior decompression surgery can make the compression of spinal cord to be completely and safely relieved for thoracolumbar fractures with spinal cord injuries, and be used for the recovery of postoperative neurological function. The titanic plate fixation and structural bone graft can recover the stability of injuried spine with excellent bony fusion.