前路减压钛网植骨融合内固定治疗胸腰段脊柱骨折合并脊髓损伤

Surgical treatment of one level thoracolumbar vertebral fracture complicated with spinal cord injury by anterior decompression and instrumentation

目的探讨前路减压钛刚植骨融合内固定术治疗单节段胸腰段脊柱骨折合并脊髓损伤的临床效果。方法自2004年5月至2007年11月应用前路减压钛网植骨融合内固定术治疗63例单节段胸腰段脊柱骨折合并脊髓损伤患者，应用ASIA脊髓损伤神经功能评定法评价患者手术前、后的神经功能恢复情况。结果全部病例均获得至少1年随访，至末次复查时，全部病例均获得植骨融合，内固定物无松动，脚腰段脊柱生理弯曲得以维持，无继发后凸畸形及椎管狭窄。与术前比较，患者术后ASIA脊髓神经损伤分线明显改善，脊髓神经感觉（t=2．759，P=0．025）、运动（t=4．616，P〈0．05）功能评分均显著提高，差异有统计学意义.结论采用前路减压钛网植骨融合内固定治疗单节段胸腰段脊柱骨折具有减压彻底、神经功能改善率高、一期内固定植骨融合成功率高、脊柱稳定性好等优点，足治疗胸腰段脊柱骨折的有效方法。

Objective To evaluate the clinical outcomes of anterior decompression combined with bone graft and,internal fixation for the treatment of one level thoracolumbar vertebra] fracture （TVF） plus spinal cord injury. Methods From May 2004 to November 2007, 63 cases of one level TVF were treated in our department with anterior decompression combined with bone graft and fixation （male： 51; female： 12）. The neurological status was evaluated fi^r all cases by the America Spinal Injury Association （ASIA） scoring system before and after surgery. All statistical analyses were accomplished by software package SPSS 13.0. Results All cases were followed up for at least 1 year. By the final follow-up, all cases had got rigid bony fusion with nearly normal spinal curvature, and no fixation loosening or secondary stenosis had been found by CT scans and MRI images. Cumpared with preoperational ASIA scores, neurological functions were recovered significantly at the final follow-up in most cases （ P 〈 0.05）. Conclusion One level TVF can be treated satisfactorily with anterior decompression combined with titanium-cage-assisted bone graft and fixation to reconstruct thoracolumbar spinal curvature and stability, and provide entire and direct decompression of the spinal cord.