侧前方手术治疗脊柱胸腰段陈旧性骨折

Anteriolateral operation for old thoracolumbar fracture

目的探讨侧前方减压或前后联合入路治疗陈旧性胸腰段骨折患者的手术方式及其疗效。方法32例胸腰段陈旧性骨折患者，30例采用侧前方减压植骨融合术，其中单纯侧前方减压植骨融合术11例，加Kaneda内固定3例，加Z-Plate钢板内固定术7例，加钛网＋Ventrofix／单棒Moss内固定术9例；采用前后联合入路减压内固定术2例。结果术后随访6～79个月，平均32个月，植入骨块均获得骨性愈合。24例患者肢体疼痛症状有所缓解，Frankel分级：3例A级术后无明显变化；7例B级恢复至C级3例，D级1例；C级11例恢复至D级5例；D级8例恢复至E级2例，7例患者术后恢复的高度有轻度丢失，Cobb角5°～18°。结论陈旧性胸腰段骨折的患者，若椎管前方脊髓神经受压表现或创伤性脊柱侧弯，采用侧前方减压或前后联合入路手术治疗可获得较为满意疗效。

Objective To investigate and summarize the surgical approach and efficacy and clinical meaning of the old thoracolumbar fracture. Methods 32 cases who suffered from old thoracolumbar fractures underwent the surgical treatment, of which 11 cases were treated with anteriolateral decompression and fusion,9 cases with anteriolateral decompression and fusion and Z-Plate internal fixation, 3 cases with anteriolateral decompression and fusion and Kaneda internal fixation, 7 cases with anteriolateral decompression and fusion with titanium mesh and Ventrofix or mono-Moss internal fixation, 2 cases with anterioposterior decompression and internal fixation. Results The mean follow-up time was 32 months（ranging 6 -79 months）. All implanted bone got fusion. 24 cases with pain of body got remission. 3 cases of grade A had no improvement. 3 cases of grade B transferred to grade C, 1 cases of grade B to grade D, 5 cases of grade C to grade D, 2 cases of grade D to grade E. Spinal height got little loseness in 7 cases. Cobb angle were 5°-18°. Conclusions The way of anteriolateral approach decompression or anterioposterior approach decompres- sion can obtain satisfactory efficacy relatively in the patients of old thoracolumbar fracture on the condition that spinal cord or nerve was compressed from ventral sides or scoliosis was occurred.