前路减压植骨内固定治疗胸腰椎骨折(附56例报告)

Clinical outcomes of the treatment of thoracolumbar vertebral body fracture by anterior decompression combined with autografts and internal fixation (56 cases report)

目的探讨前路减压、植骨融合内固定治疗胸腰椎骨折的临床效果。方法2003年1月～2008年12月,采用前路减压、植骨内固定术治疗胸腰椎骨折56例,其中合并不全截瘫44例,椎管骨性占位,硬膜受压,但无神经症状12例。观察其神经功能的恢复情况和脊柱的稳定性。结果56例随访7个月～5年,平均2.6年。伤椎高度恢复90%以上35例,恢复80%～90%16例,恢复80%以下5例。X线片显示植骨融合,无钢板螺钉断裂和松动现象。44例不全截瘫者术后脊髓神经功能按Frankel分级,除A级3例未能恢复外,其余恢复1～2级。结论对来自椎管前方压迫的胸腰椎骨折,前路减压植骨钛板固定具有减压彻底、神经功能改善率高、一期固定融合成功率高及脊柱稳定性好等优点,是治疗胸腰椎骨折的有效方法之一。

[Objective] To explore the clinical outcomes of the treatment thoracolumbar vertebral body fracture by anterior decompression combined with autografts and internal fixation. [Methods] Fifty-six cases with thoracolumbar fracture were treated by anterior decompression, reduction, autogenous iliac grafting and fixation between Jan. 2003 and Dec. 2008. Fourty-four eases out of them are suffered from spinal cord injuries. Twelve cases out of them were free from spinal cord injuries although suffering from fracture of thoracolumbar vertebral body and spinal dura mater compressed. The nerve function of spinal cord and spinal stability were evaluated benefiting from anterior decompression combined with autografts and internal fixation. [Results] All cases had been followed up for 7 months to 5 years with an average of 2.6 years. No complications occurred, such as breaking of the plate and screw, the height of fracture vertebra of 35 cases had recovered above 90%, 16 cases had recovered 80%~90%, 5 cases had recovered no more than 80%. All the patients suffered from spinal cord injuries had recovered 1 to 2 nerve function of spinal cord basing on the Frankel grades system, except 3 cases whose spinal cord function were A Frankel grade. [Conclusion] The anterior decompression is an effective way for thoracolumbar fractures combined with spinal injuries, for it can attain complete de-compression, high recovery rate of the nerve function, high rate of fixation and fusion at one stage and good spinal stability.