胸腰椎骨折后路手术失败,前路二次手术的体会

The effects of two-stage anteror approach procedure after the failure of posterior surgical operation of thoracolumbar fracture.

目的探讨胸腰段脊柱骨折后路手术失败再手术的疗效.方法对18例胸腰椎骨折行后路减压、固定失败的病例再手术行前路减压及固定,根据患者感觉、运动、括约肌功能、Cobb's角等比较.结果术后复查X线片,CT和MRI,椎管侵占程度从平均28%降到6%;Cobb's角从平均19.降到8.;Frankel分级均升高1～3级.结论胸腰段脊柱骨折后路手术失败的病例,掌握好手术指针的情况下,选择前路再手术可以彻底减压,纠正畸形,有利于瘫痪的恢复.

Objective To analyse the cause of the patient＇ s internal fixation failure of incomplete decompression and summarize the necessity and importance of two-stage anterior approach procedure. Methods Among eighteen cases of thoracolumbar fracture, 3 case is the patients with the spinal cord compression for internal fixation failure, 12 cases with internal fixation failure and incomplete decompression,5 cases with simple incomplete decompression. All these patienas were removed interual fixator through posterior approach in combination with decompression,bone grafting fusion, rectifying deformity an fixation with K-plate or Z-plate, mean while the patients＇articular process with fusion were resected. Results Vertebral kyphotic deformity in all 18 cases disappeared postoperatively, the neurologic function have improvement of i to 3 grade by frankel grading system. Conclusion The two-stage anterior approach operation of thoracolumbar fracture with the one stage internal fixation failure or inomplete decompression can recity detonnity, remove spinal cord or incomplete decompression and facilionte the recoveng of the neurologic function and improve the value of live.