胸腰椎爆裂骨折手术入路的选择

The selection of operative approach for thoracic and lumbar vertebra burst fracture

目的探讨前路、后路和前后联合入路手术治疗胸腰椎爆裂骨折的优缺点。方法采用三种不同的手术入路治疗腰椎爆裂骨折43例,其中经后路29例,前路11例,前后联合入路3例。采用ASIA标准评定神经功能恢复情况,通过影像学检查比较伤椎和Cobb角的矫正及丢失,评估椎管减压范围、植骨块位置及愈合情况。结果43例随访5～36个月,平均12个月,术前不完全性损伤的37例患者神经功能恢复≥1级。脊髓神经功能术前为A级5例,术后均无恢复。结论胸腰椎爆裂骨折术式的选择取决于脊柱稳定性、神经损伤情况以及椎管内占位程度。具体应根据伤椎椎体压缩程度、椎管内骨性占位程度、是否伴有脊柱后柱结构不稳或骨折脱位来决定。

Objective To investigate the advantages and disadvantages of anterior, posterior or com- bined surgery for thoracic and lumbar vertebra burst fracture. Methods 43 cases for three approaches for tho- racic and lumbar vertebra fracture, including 29cases for posterior approach, 11 eases for anterior approach, 3 ca- ses for anterior and posterior approach. Evaluating nerve function recovering on ASIA comparing correction and lose of fractured vertebra and Cobb angel through imagination. Evaluating depressing range for vertebra canal, position of implanting bone and fracture recovery. Results 43 cases were followed up for 5-36 months（ average 12 months） ,nerve function of recovered 1 grade or more in 37 cases which nerve function incomplete injure in pre-operation,5 cases with A grade in pre-operation recovered nothing. Conclusion Selecting operative ap- proach depends on spinal stability, injury of nerve and grade of protrusion of bone in the vertebra canal. The ver- tebral compression, canal encroachment,posterior column stability and concomitant displacement should be considered in the choice of appreciate surgical approach.