经后路椎弓根钉内固定加钛网骨移植椎间融合治疗胸腰椎爆裂骨折

Transpedicular corpectomy with Meshcage and pedicle screw fixation in treatment of thoracolumbar/ lumbar burst fractures

目的探讨胸腰椎骨折经后路切除伤椎的可行性及临床效果。方法2006年4月至2007年6月，经后路椎弓根钉内固定、伤椎切除及钛网骨移植椎间融合术治疗胸腰椎爆裂骨折27例，男21例，女6例；年龄22～53岁，平均33．6岁。骨折节段T11 3例，T12 7例，L1 9例，L2 6例，L0 1例，L4 1例。采用Frankel分级标准评定神经功能恢复情况。术前神经损伤程度按Frankel分级标准：A级8例，B级13例，C级6例。结果27例患者术后获3～12个月（平均8．2个月）随访。术后压迫脊髓的骨块完全切除，Cobb角平均3．2°，脊柱恢复生理曲度。术前19例不完全性神经损伤患者神经功能恢复一级或一级以上；8例完全性神经损伤患者中，5例无改善，2例神经功能由A级恢复至C级，1例由A级恢复至D级。结论对于三柱损伤的急性胸腰椎骨折患者，应用经后路椎弓根钉内固定、伤椎切除及钛网骨移植椎间融合术治疗，能彻底切除压迫脊髓的前方骨块，具有骨折复位满意、手术创伤小及并发症少等优点。

Objective To investigate the feasibility and clinical outcome of transpedicular corpectomy with Meshcage and pedicle screw fixation in the treatment of thoracolumbar/lumbar burst fractures. Methods Twenty-seven patients with thoracolumbar/lumbar burst fracture were treated by posterior pedicle screw reduction and corpectomy with titanic Meshcage implantation from April 2006 to June 2007. This group included 21 males and 6 females, with an average age of 33.6 （22 to 53） years. There were 3 cases of Tll fracture, 7 T12 fracture, 9 LI fracture, 6 L2 fracture, 1 L3 fracture, and 1 IA fracture. Pre- and post-operative data were recorded in detail. According to the preoperative X-ray images, the average spinal canal occupational ratio was 70. 5% and average segmental Cobb angle was 32.2°. Neurological functions were evaluated by Frankel Grading system. Results All patients were followed up for 3 to 12 months, with a mean period of 8.2 months. After the blocks compressing the nerve were removed, the postoperative Cobb angle averaged 3.2° and the spinal curve was restored. Of the 8 patients with complete neural lesion, 2 had 2-grade improvement, 1 had 3-grade improvement but the other 5 had none. The other 19 patients who had suffered incomplete nerve injury showed improvement to different extents. There were no other compli- cations in this group. Conclusions Transpedicular corpectomy, Meshcage and pedicle screw internal fixation and autogenous bone graft can be a very good treatment for thoracolumbar/lumbar burst fractures, because it can spare the trouble of surgery through combined anterior and posterior approaches, resulting in satisfactory reduction, complete decompression, little operative invasion and few complications.