前路减压内固定治疗胸腰椎爆裂骨折并截瘫

Anterior Decompression and Internal Fixation for Thoracolumbar Spinal Burst Fracture with Paralegia

目的探讨前路减压内固定治疗胸腰椎爆裂骨折并截瘫的临床疗效。方法回顾经前路减压内固定手术治疗的21例胸腰椎爆裂骨折并截瘫的病例,并分析前路手术的优缺点、适应证及内固定的选择。结果所有病例脊髓均获得有效减压,15例获得随访,术后平均随访5.5年,发现植骨块融合良好,伤椎高度基本恢复,Cobb′s角由术前平均17°恢复到5°,Frankel分级恢复一级者5例,恢复二级者5例,无变化者5例。结论前路减压内固定术是集减压、复位、内固定、植骨融合、矫正畸形、重建脊柱稳定一次完成的有效方法,但手术创伤大,出血多,应严格掌握手术指征。

Objective To evaluate the clinical efficiency of anterior decompression and internal fixation for thoracolumbar spinal burst fracture with paraplegia. Methods 21 cases of thoracolumbar spinal burst fracture with paraplegia treated by anterior decompression and internal fixation were reviewed which the advantages and disadvantages, indications and options of internal fixation were analyzed. Results All spinal cords were decompressed effectively and all cases were followed up in the average of 5.5 years. The height of fracture vertebrae was recovered. The Cobb＇s kyphosis angle was recovered from 17°preoperatively to 5°postoperatively. Besides ,one grade was improved in 5 cases and 2 grade in 5 cases for Frankel grade scores. There was no improvement in 5 cases. Conclusion The method of anterior decompression and internal fixation is an effective approach which the decompression,reduction,internal fixation, bone grafting,deformity correction and reconstruction of spinal stability can be performed at one stage. But the main disadvantages are large injury and much hemorrhage in the operation. The operative indications must be strictly mastered.