后侧入路重建脊柱前中柱技术的安全性及疗效分析

Analysis of safety and effect of the technique of reconstructing anterior and middle columns by single posterior approach

目的:探讨在腰椎爆裂骨折的治疗中应用经单一后侧入路植入钛网重建椎体前中柱技术的安全性及疗效。方法:自2005年7月至2007年1月,对22例腰椎爆裂骨折患者(男18例,女4例,年龄28～57岁,平均42.7岁),采用单一后侧入路截除骨折椎一侧横突,从侧方对前中柱骨折碎块进行清理,行椎管扩大减压成形,然后置入填塞自体松质骨的钛网重建椎体前中柱。同时,采用后路短节段椎弓根螺钉系统固定骨折椎邻近上下节段椎体。记录手术时间、术中出血量、手术前后骨折椎椎体部位高度、脊柱后凸畸形程度、椎管内占位情况等。结果:手术时间平均3.5h(2.8～5.8h),术中出血量平均820ml(650～2100ml)。所有患者均获随访,随访时间12～28个月,平均17.2个月。术后,骨折椎椎体高度由术前平均压缩至(23.70±9.31)%恢复至正常高度的(95.77±1.93)%(P<0.05),脊柱生理曲度恢复,椎管内压迫完全解除。术后3例发生短暂的神经根牵拉伤,1例术后3个月时发生椎弓根螺钉系统连接杆松动。结论:通过单一的后侧入路向前侧植入钛网重建腰椎爆裂骨折的前中柱技术安全性可靠,应用于腰椎爆裂骨折的治疗有良好的疗效。

Objective：To explore the safety and effect of the technique of reconstructing anterior and middle column by posterior approach in treatment of lumbar burst fractures. Methods：From July 2005 to January 2007,22 patients of lumbar burst fractures （ 18 males and 4 females, the age was from 28 to 57 years old with an average of 42.7 years） were treated as the following surgical procedures：based on the routinal posterior approach,one of the transverse process of the injured vertebral was incised to get access to the lateral side of the injured vertebral body. After cleaning of all the displaced fracture fragments and decompressing the spinal canal,the titanium mesh packed with autografts were implanted from lateral side to reconstruct the anterior and middle column. The above and below adjacent vertebral body were fixed by transpedicular screws. The operative time,intraoperative blood loss,vertebral height,degree of kyphotic deformity and comprised spinal canal were recorded. Results ：Tbe average operative time was 3.5 h （2.8-5.8 h） and the average blood loss was 820 ml （650-2 100 ml）. All the patients were followed up with an average 17.2 months （from 12 to 28 months）. The height of the injured vertebral body were restored from （23.70±9.31）%preoperative to （95.77±1.93）%postoperative （P〈0.05）. The natural spinal curvatures and spinal canal were restored. Three cases were involved in transient iatrogenic nerve root injury. And 1 case was involved in the loosen- ing of the connected rod of the pedicle screw system at 3 months after operation. Conclusion：The technique of implanting the titanium mesh by posterior approach was effective and safe enough to reconstruct the anterior and middle column in treating lumbar burst fracture. With this technique, good results could be achieveded.