严重胸腰椎骨折-脱位的手术治疗

Surgical Treatment for Severe Thoraco-lumbar Spine Fracture-dislocation

目的探讨严重胸腰椎骨折-脱位的手术治疗方案及其重建效果. 方法回顾性分析1996年1月～2004年12月收治的25例严重胸腰椎骨折-脱位患者的影像学资料特点、手术治疗方案及复位重建的效果.对于以脱位和后部附件骨折为主的23例患者行后路减压椎弓根螺钉系统复位、固定及植骨融合,对于脱位合并有前方椎体严重骨折和后部附件骨折的2例则先行后路复位减压固定,然后一期行前路骨折椎体切除及髂骨植骨融合固定. 结果本组前后脱位均得以纠正,1例侧方脱位未完全纠正.23例骨折椎体高度和形态恢复良好,2例因骨折椎体复位不良而加做前路重建术.椎体前缘高度平均恢复20 (18～22)mm, Cobb's角平均纠正35° (30°～40°). 结论对于严重的胸腰椎骨折-脱位应根据椎体骨折的程度和后部附件损伤的程度而采用不同的手术方案.对于以脱位和后部附件骨折为主的损伤病例可只行后路减压复位固定融合;对于脱位合并有前方椎体严重骨折及后部附件骨折者则宜先行后路复位减压固定,然后一期行前路骨折椎体切除植骨融合固定.

Objective To investigate the effective surgical treatment and reconstructive result for severe thoraco-lumbar spinal fracture-dislocation. Method 25 cases of severe thoraco-lumbar spinal fracture-dislocation from January 1996 to December 2004 were retrospectively reviewed with respect to radiological findings, surgical procedure and repositioning result. Posterior approach with decompression, reduction, fixation and bone implantation were selected for 23 cases of dislocation and postrior accessory fracture. The rest 2 cases of dislocation, anterior and posterior accessory fracture underwent posterior reduction, decompression and fixation followed with anterior resection of fractured vertebral body and bone graft implantation fixation. Result All dislocation rectified except incomplete reduction in 1 case of lateral dislocation. The height and shape of fractured vertebral body recovered well in 23 cases, the rest 2 cases underwent further anterior reconstruction due to malreduction of fractured vertebral body. The anterior height of vertebral body elevated 20(18～22)mm, Cobb's angle corrected in 35°(30°～40°). Conclusion Posterior decompression and fixation is appropriate for dislocation and posterior accessory fracture, whereas a further anterior resection of fractured vertebral body and bone graft implantation should be performed in case of severe anterior vertebral fracture.