胸腰椎爆裂型骨折侧前方减压内固定治疗的技术改进

Technical improvement for anterlateral decompression with fixation in treatment of thoracolumbar burst fractures

目的针对侧前方减压内固定治疗胸腰椎爆裂型骨折手术创伤大、失血多、技术要求高等问题进行技术改进，并评价改进后技术的优缺点。方法11例患者采用传统经腹膜外入路即常规程序作为对照组，16例选择采用改良“L”形胸腰联合切口（经第11～12肋胸膜外一腹膜后入路）及改进程序。比较2组间在手术时间、出血量等方面是否存在差异，并观察术中、术后并发症情况。结果27例胸腰椎骨折并截瘫患者手术均获成功。技术改进后术中平均出血量450mL，手术操作时间平均119min，手术切口平均长度17cm．。随访4-13个月，平均9．6个月。术后无截瘫加重，脊柱序列正常，无植骨块塌陷及高度丢失现象，无假关节形成和内固定失败。神经功能获1级以上恢复者达94％。结论该技术改进具有切口短、出血少、手术创伤较轻、降低手术操作难度的优点。

Objective To evaluate the results and advantages of the technical improvement for anterlateral decompression with fixation in treatment of thoracolumbar burst fractures. The improved procedure was to avoid the defects in traditional approach, such as larger trauma, more blood loss, higher request for surgical technique, etc. Methods Eleven of the 27 cases were treated by conventional approach. The modified ＂L＂ shaped anterlateral approach to thoracolumbar junction extrapleuralretroperitoneal approach from the 1 lth rib to the 12th rib was used in the rest cases. The average operation time, amount of blood loss as well as introperative and postoperative complications were observed and compared between the 2 groups. Results All of the 27 cases got successful surgery. The average amount of blood loss was 450 mL, and the average operation time was 119 min, and the average length of incision was 17 cm. After an average period of 9.6 months （ranged from 4 to 13 mouths） follow-up, none of the patients had neurological deterioration, and the spine recovered normal sequence with the fusion rate of 100% and no failure in implant and fixation. Neurological function was improved at least 1 grade in 94%. Conclusion Compared with tradition approach, the technical improvement for anterlateral decompression with fixation in treatment of thoracolumbar burst fractures obtains shorter incision, less blood loss, smaller trauma, and less difficulty in operative procedure.