后外侧减压植骨融合内固定治疗胸腰段爆裂骨折

Treatment of the Thoracolumbar Fractures with Posterolateral Decompression Combined Bone Infusion and Internal Fixation

目的探讨后外侧减压复位植骨融合内固定治疗胸腰段爆裂骨折的疗效。方法自2003年6月至2007年6月本组共收治胸腰段爆裂骨折患者83例,其中T1114例,T1225例,L131例,L213例。根据Dennis骨折分型,其中型32例,型7例,型13例,型25例,型6例。所有患者均采用后外侧减压复位植骨内固定治疗,记录术中出血量、手术时间;随访术后1个月、1年时的椎体高度、Cobb角变化情况,记录患者入院及治疗后6个月、1年时的ASIA下肢运动功能评分(Asiamotorscore,AMS)并进行比较。结果83例患者均获随访,平均19个月(8～60个月),平均手术时间为(2±0.3)h,透视时间(15±4)min,出血(400±12)mL,术前AMS评分为(43.7±11.3)分,术后6个月为(70.9±9.4)分,术后1年为(78.6±9.3)分,手术前后AMS评分之间有显著性差异(F检验,P<0.05)。术前脊柱后凸角(Cobb角)平均(26.23±3.6)°,术后1年为(8.90±6.42)°,术后1年Cobb角增加(5.49±6.10)°,手术前后两者有显著性差异(F检验,P<0.05)。术前伤椎平均高度(18.5±1.2)mm,术后1年为(23.1±1.6)mm,平均增加(5±0.4)mm,和术前相比存在显著性差异(t检验,P<0.05)。结论后外侧减压复位植骨内固定是治疗胸腰段爆裂骨折的一种有效方法,手术创伤小、简单易行、并发症少且能够有效维持脊柱稳定,促进脊髓神经功能恢复。

Objective To treat the thoracolumbar fractures with posterolateral decompression combined bone infusion and internal fixation and to evaluate its efficiency. Methods During Jun 2003 to Jun 2007,83 thoracolumbar fracture patients received operation in our hospitals. According to the Dennis classification,there were type Ⅰ 32 cases,type Ⅱ 7 cases,type Ⅲ 13 cases,type Ⅳ 25 cases,type Ⅴ 6 cases. All of them were treated by posterolateral decompression combined bone infusion and internal fixation. Results All the patients were followed from 8 months to 5 years ,the amount healing time was 26 weeks .the average fixation time was 34 weeks. Among them,there were 8 cases pin tract infection, 1 case of skin allergy,2 cases of malunion. Conclusion It was an easy and effective way to treat the thoraeolumbar fractures with posterolateral decompression combined bone infusion and internal fixation.