前路"Z"形钢板治疗胸腰椎爆裂型骨折

The Use of Z-Plate Instrumentation in the Treatment of Fresh Burst Fractures of the Thoracolumbar Spine

目的探讨前路减压及"Z"形钢板内固定在治疗胸腰椎爆裂型骨折中的价值和作用。方法自1999年8月-2002年3月,对26例胸腰椎爆裂型骨折患者行"椎管前方减压、植骨融合、Z-plate钢板内固定术",观察手术疗效。结果获随访19例,随访时间11月-2年10个月,平均1年11.2个月。所有病例均达到骨性融合,无内固定失败病例。17例不完全神经损伤患者中,术后有12例Frankel分级改善。矢状面指数(SI):术前为10度-41度,平均24.2度;术后12月3度-9度,平均4.7度。CT椎管受损百分比度:术前为35%-67%,平均42.3%;术后为0%-10%,平均4.6%。结论采用椎管前方减压及"Z"形钢板固定治疗胸腰椎爆裂型骨折,可以获得满意的临床疗效。"Z"形钢板可以提供良好的脊柱稳定性。

Objectives To evaluate the efficacy of anterior decompression and Z-plate instrumentation for the treatment of fresh thoracolumbar burst fractures. Methods In the period of 1999-2002, 26 patients with fresh thoracolumbar fractures were operated with anterior decompression, bone graft and Z-plate instrumentation. Results Evaluated were 19 patients, Average interval after the surgery at the time of the evaluation was 23.2 months (range, 11-34 months). All patients healed solidly without instrumentation failure. 12 of 17 patients with incomplete lesions improved postoperatively according to Frankel grades. Average preoper-ative Sagittal Index (SI) was 24.2 degrees (range, 10-41 degrees), which improved to an average of 4.7 degrees (range, 3-9 degrees) after surgical treatment. And average preoperative canal narrowing (CN) was 42.3% (range, 35%-67%), which improved to an average of 4.6% (range, 0-10%) postoperative. Conclusions Anterior decompression and Z-plate instrumentation can yield successful clinical results in the treatment of thoracolumbar burst fractures. Z-plate instrumentation provides stable fixation.