前路减压固定植骨融合治疗脊柱胸腰段骨折46例分析

Anterior decompression,internal fixation and fusion for treatment of thoracolumbar fractures

目的探讨经前路椎体部分切除减压内固定植骨融合治疗脊柱胸腰段骨折的价值。方法回顾性分析2004年6月至2009年6月采用前路减压内固定植骨融合治疗46例脊柱胸腰段骨折患者的临床资料，以及随访结果比较，观察其局部脊柱的稳定性和神经功能恢复。结果46例患者术后无神经功能损害加重，所有患者得到随访，随访时间为0．5—5年，平均2．2年。X线片提示后凸Cobb角由术前平均26°恢复到3°，畸形得到纠正，植骨均已融合，伤椎高度平均恢复94．5％，未出现钉棒松动、断裂。神经功能ASIA分级恢复A级2例，B级2例，C级4例，D组10例，E组8例（χ^2=16．327P〈0．01）。结论对于来自椎管前方压迫的脊柱胸腰段骨折采用前路减压具有减压彻底、神经功能改善率高、Ⅰ期内固定植骨融合成功率高、脊柱稳定性好等优点，是治疗脊柱胸腰段骨折的有效方法。

Objective To investigate the curative values of anterior decompression, internal fixation and fusion in treatment of thoracolumbar fractures. Methods Date of 46 cases with thoraeolnmbar fractures treated with anterior decompression ,internal fixation and fusion from June 2004 to June 2009 were retrospectively analyzed and compared with the follow up results of all cases to observe spinal stability and nerve functional recovery. Results No aggravation of nerve injury appeared in 46 cases. All cases were followed up for 0. 5 - 5 years,with an average of 2. 2 years. The result that the grafted bone had good fusion in all cases, of which, none was found with broken nails and canes. The height of fracture vertebrae was recovered by 94. 5% on average. The cobb＇ s kyphosis angle was recovered from 26 °preoperatively to 3 ° postoperatively. Besides, one grade was improved in 23 cases for ASIA grade scores,2 grades in 9 cases and 3 grades in 2 cases, no improvement in 5 cases（ χ^2 = 16. 327 P 〈 0. 01 ）. Conclusion The method of anterior decompression and internal fixation is an effective way for thoracolumbar burst fractures, for it can attain complete decompression, high recovery rate of the nerve function, high fusion rate of the grafted bone at one stage and good spinal stability.