前路手术治疗胸腰椎爆裂骨折伴截瘫73例

Anterior Approach Surgery for Thoracolumbar Burst Fracture with Paraplegia:A Clinical Observation of 73 Cases

目的探讨前路手术治疗胸腰椎爆裂骨折伴截瘫的价值。方法对前路手术治疗65例胸腰椎爆裂骨折伴截瘫进行分析。结果伤椎椎管侵占率、椎体压缩率、后凸Cobb角术后初次及末次复查较术前有显著性差异(P<0.05),术后末次较初次复查无明显变化(P>0.05);神经功能ASIA分级术后绝大部分有1～3级的提高;植骨全部融合;发生轻度脊柱侧弯3例、后凸2例,内固定松动、钛网内陷1例;肺部感染l例、下肢深静脉血栓1例。结论前路手术是治疗胸腰椎爆裂骨折伴截瘫的良好方法。

Objective To investigate the application value of anterior approach surgery for thoracolumbar burst fracture with paraplegia. Methods A retrospective analysis was made of 65 cases of thoracolumbar burst fracture with paraplegia which underwent anterior surgery. Results The injured vertebral spinal canal encroachment rate,vertebral body compression ratio and kyphosis Cobb angle showed significant difference at the first review and last review after surgery compared with those before surgery（P〈0.05 ）. But showed no significant difference at the first review after surgery compared with those at the last review after surgery（P〉0.05）. According to the neurological function ASIA grading, the majority cases increased a 1-3 grade level after surgery, and all were cured with bone fusion in all bones, mild scoliosis in 3 cases, kyphosis in 2 eases, internal fixation loosening and titanium mesh invagination in one case, pulmonary infection in one case and deep venous thrombosis in one case. Conclusion The anterior approach surgery is a good therapy way for thoracolumbar burst fracture with paraplegia.