胸腰椎爆裂骨折后路侧前方减压钢板固定的疗效观察

Observations on the effects of posterior lateral-anterior decompression and plate fixation in the treatment of thoracolumbar vertebral burst fracture

[目的]探讨胸腰椎爆裂骨折后路侧前方减压钢板固定术的疗效。[方法]回顾性总结分析2002年1月～2007年9月85例胸腰椎爆裂骨折行后路侧前方减压钢板固定手术。随访12个月～5年4个月(平均2年4个月),进行临床Denis疼痛评分,调查患者对手术的满意程度,测量术前、术后后凸角度,椎体高度丢失的百分数,观察神经功能恢复情况。[结果]所有病例均获得随访,按照Denis疼痛分级,P1级有61例患者无疼痛,P2级有24例患者有轻微疼痛,无需服药治疗,所有患者均对手术表示满意。85例胸腰椎爆裂骨折X线片可见椎体后凸畸形矫正满意,椎体高度恢复较好,术前后突成角平均26.8°,术后为7.8°。术前椎体高度丢失平均为58.5%,术后平均为5.6%。骨折愈合时间平均为6.3个月。70例有Frankel一级以上的改善,术后42例神经功能完全恢复。无内固定物断裂、松动、脱出,所有病例均获得骨性融合,无假关节形成。[结论]经后路侧前方手术减压、固定可同时进行,入路简单,减压充分,固定可靠,重建了脊柱的稳定性,脊髓神经功能可获得最大程度的改善。

[ Objective] To investigate posterior lateral-anterior decompression and plate fixation in the treatment of thoracolumbar vertebral burst fracture. [ Method ] Totally 85 patients with thorocalumbar burst fracture were retrospectively analyzed, which were operated by posterior lateral-anterior decompression and plate fixation. The follow-up time was 12 months -5 years and 4 months （average 2 years 4 months）. Patients were assessed by clinical evaluation and radiographic study. [ Result] All patients were followed up. According to Denis pain classification,61 patients had no pain,24 patients had occasional pain but no medication treatment. All patients were satisfied with the surgery. The preoperation posterior prominence angle was 26.8° and postoperation angle was 7.8°. The vertebral body hight had lost 58.5% before operation and lost 5.6% after operation. Fracture healing time was 6.3 months. Seventy patients had improved by one grade or more according to Frankel＇ s grading. Forty-two patients＇ nerve function had recovered completely. There was no implant break, loosening, extrusion. All cases had bony fusion, without the formation of pseudoarthrosis. [ Conclusion ] Posterior decompression and plate fixation can be carried out simultaneously. The technique is simple. It can achieve full decompression and reliable fixation. Spinal stability is reconstructed and the spinal cord nerve function can be improved to the greatest degree.