胸腰椎爆裂型骨折并截瘫患者术后脊髓功能恢复与手术方式及内固定系统的相关性(英文)

Relationship between recovery of spinal function and decompression with internal fixation types in patients with thoracolumbar burst fracture and paraplegia

背景:胸腰椎爆裂型骨折的主要危害是原发和/或继发性损伤所造成的脊髓神经损伤,有报道经后路器械复位内固定对爆裂骨折的复位和对椎管的间接减压是有效的。目的:探讨经前路减压后应用史塞克胸腰椎前路钢板内固定系统治疗胸腰椎爆裂型骨折并截瘫患者,改善术后椎管狭窄及脊柱力线的效果。设计:病例报告。单位:一所市级医院骨科。对象:选择2001-09/2002-02东莞市太平人民医院骨科收治的胸腰椎爆裂型骨折并脊髓功能障碍患者5例,男4例,女1例;年龄17～34岁。方法:对5例患者进行前路彻底减压,取髂骨或/和肋骨行椎间植骨,应用史塞克胸腰椎前路钢板内固定系统进行复位、内固定。于术后1,3,5,9个月拍X射线片,观察植骨融合情况、椎管狭窄面积及后凸角改善效果;随访时采用Frankel分级评定脊髓功能(A级为差,E级为优)。主要观察指标:①手术前后脊髓功能Frankel分级。②后凸成角情况及椎管狭窄面积。结果:5例患者均进入结果分析。随访时间8个月。①椎间植骨全部完全融合,融合时间平均4个月。②Frankel分级除1例患者达2级以上改善外,其余患者均获得行走功能,Frankel分级达E级。③椎管狭窄面积术前平均为68.9%,术后椎管无狭窄。④术前脊柱后凸成角15°～30°,术后为0°～6°,术后脊柱后凸角较术前明显改善。结论:经前路减压直接彻底,为脊髓神经功能的恢复提供了良好环境。史塞克胸腰椎前路钢板内固定系统治疗胸腰椎爆裂型骨折并截瘫患者可以有效地恢复脊柱生理弯曲,且操作简单,固定牢固,具有内固定材料的生物学特征。

BACKGROUND:The most dangerous consequence of thoracolumbar burst fracture is its neurological deficits(caused by primary and/or secondary injury).It is reported that posterior spinal decompression combined with internal fixation are viable in reduction of fracture and indirect decompression of obstructed spinal canal. OBJECTIVE:To evaluate the effect of anterior decompression combined with STRYKER thoracoluambar anterior internal fixation system in improving spinal canal stenosis and spinal mechanical axis in thoracolumbar burst fracture. DESIGN:It is a case report. SETTING:An orthopedic department of a municipal hospital. PARTICIPANTS:In this study,five patients (four male, one female, aged 17-34 years) were recruited who suffered from thoracolumbar burst fracture and spinal cord dysfunction and were treated in the Orthopaedic Department of Dongguan Taiping People's Hospital from September 2001 to February 2002. METHODS:All patients received anterior decompression and intervertebral grafting with iliac or rib bone flap combined with reduction and internal fixation by STRYKER system.X-rays of thoracolumbar vertebrae were taken in the 1st,3rd,5th and 9th post-operative months for observation of fusion of injured segments,improvement of narrowed spinal canal and kyphosis angle.And Frankel scale was adopted for evaluation of the patients during follow-up(A for bad and E for excellent). MAIN OUTCOME MEASURES:①The Frankel grading of every patient before and after surgical treatment.②kyphosis of spine and the area of narrowed spinal canal. RESULTS:All of the 5 patients entered analytic stage and follow-up lasted for 8 months.①Intervertebrally-implanted bone flaps fused with injured vertebra and the mean time for fusion is 4 months.②Except for Frankel grade B in one patient, all the others got Frankel grade E and could walk independently.③The mean percentage of spinal canal stenosis before surgical operation was 68.9%and after operation there was no spinal canal stenosis.④Kyphosis angle was also improved from 15°-30°before operation to 0°-6°afterward. CONCLUSION:Anterior spinal decompression can directly and completely provide satisfactory environment for the recovery of neurological of deficits spinal cord.STRYKER thoracoluambar anterior internal fixation system applied in patients with thoracolumbar burst fracture and paraplegia can effectively restore normal spinal curve with the advantages of simple procedure and stable fixation as well as the characteristics of biological internal fixation such as satisfactory reduction and stable fixation.