合并椎管内骨块的胸腰椎爆裂性骨折的后路处理

Surgical Treatment by Posterior Approach for Thoracolumbar Bursts Fractures with Bone Fragments in Vertebral Canal

目的评价胸腰椎爆裂性骨折椎管内骨块的处理结果。方法后路减压处理椎管内骨块,经椎弓根内固定。椎管占位<30%,无神经症状,可单纯行内固定。椎管占位<30%伴神经症状及椎管占位>30%行减压内固定,严重者辅以经椎弓根撬拨、植骨。并探讨脊髓探查的时机。结果本组26例通过3个月～3年随访,椎管占位由术前平均的38.4%恢复到术后平均的4.7%。椎体前缘高度,术前平均压缩54%,术后恢复到91.2%。椎体后缘高度,术前平均70%,术后恢复到93.1%。后凸崎形:Cobb角术前平均28°,术后为7°,神经功能:3例A级,1例恢复为B级,2例无改善;余者晋升1～2级。结论合并椎管内骨块的胸腰椎爆裂性骨折,通过后路能达到良好减压,畸形矫正,神经功能有较好的恢复。

Objective To evaluate the surgical treatment method for thoracolumbar bursts fractures with bone fragments in vertebral canal by posterior approach. Methods Twenty-six patients with thoracolumbar bursts fractures with bone fragments in vertebral canal were treated. The simple internal fixation was used in the cases that space-occupying of vertebral canal was〈 30 % and without neurological symptomds. When space occupying of vertebral canal was 〉 30 %, the decompression and transpedicular bone grafting were applied. The opportunity of spinal cord injury exploration was also investigated. Results The patients were followed up for 3 - 36 months. The space occupying of vertebral canal was reduced from preoperative 38.4 % to postoperative 4.7 %. The heights of anterior vertebral body were increased from preoperative 54 % to postoperative 91.2 %. Thc height of posterior vertebral body was improved from preoperative 70 % to postoperative 93.1%. The average Cobb angles were reduced from preoperative 28° to postoperative 7°. The neurological function was improved more than one grade. Conclusion Thoracolumbar bursts fractures with bone fragments in vertebral canal can be treated by decomprcssion, bone grafts and neurological functional recovery methods by posterior approach.