L形复位器配合椎弓根内固定治疗胸腰段爆裂性骨折

L-shaped reductors combined with pedicle screw internal fixation for the treatment of thoracolumbar bursting fracture

目的:寻找一种手术操作简单、安全、损伤小、效果好且并发症少的治疗胸腰段爆裂性骨折方法。方法:2003年3月至2006年10月共收治胸腰段爆裂性骨折34例,其中男26例,女8例;年龄18～67岁,平均42岁;受伤时间6h～7d。骨折部位:T113例,T129例,L115例,L27例。术前CT检查显示骨折椎体后壁不完整,并有骨块突入椎管压迫硬脊膜,全部病例均有不同程度的神经损伤症状。34例全部采用后正中入路,椎弓根内固定器将骨折椎体撑开后,用自制不同型号"L"形复位器将突入椎管的骨折块,自硬膜外经椎管前方向椎体内嵌压复位,并行后外侧融合。术后根据X线及CT检查,观察伤椎高度、Cobb角、椎管狭窄程度及症状恢复情况。结果:34例平均随访24个月,手术后1年伤椎椎体前后缘平均高度分别为正常的(95.23±1.9)%和(98.37±1.45)%,较术前高度增加;术后Cobb角平均为(4.93±1.41)°,较术前减小;手术1年后CT片示椎体后凸骨块占椎管前后径的比例平均为(6.77±1.57)%,较术前减小,差异有统计学意义(P<0.001)。所有神经功能术后平均改进1级以上。结论:采用"L"形复位器治疗胸腰段爆裂性骨折,具有操作简单、复位完美、固定牢靠、疗效优良等优点。

Objective：To explore the effect of self made L-shaped reductors combined with pedicle screw internal fixation for the treatment of thoracolumbar bursting fractures. Methods：From Mar. 2003 to Oct. 2006,a total of 34 patients with thoracolumbar bursting fractures were treated. Among the patients,26 patients were male and 8 patients were female,with an average age of 42 years（ranged from 18 to 67 years）. The course of injury ranged from 6 hours to 7 days. The site of fractures：3 patients in T11,9 patients in T12,15 patients in L1,7 patients in L2. Preoperative CT showed that posterior wall of the fractured vertebral body were incomplete,bone broke into the spinal canal and compressed epithet dural sac. All the patients had symptoms of varying degrees of nerve injury. The posterior median approach was adopted,and self made L-shaped reductors were used to press and restore the fractured bones that intruding to vertebral canal through the anterior of vertebral canal,then posterolateral fusion was made. Based on postoperative X ray and CT inspection the effects were observed by injured vertebral height,cobbs angle,spinal canal stenosis,and symptoms of recovery. Results：All the patients were followed up with an average of 2 years. The mean anterior and posterior vertebral height increased to normal as （95.23±1.90）% and （98.37±1.45）% respectively, which were higher than those of per operation. The post operative average Cobb angle was （4.93±1.41）°,which was smaller than that of pre operation. Postoperative CT showed that the average ratio of protruded bones to the spinal canal anteroposterior diameter was （6.77±1.57）%, which was smaller than that of pre operation. All of neurological functions were improved over one grade. Conclusion：L-shaped reductors combined with pedicle screw internal fixation for the treatment of thoracolumbar bursting fractures has many advantages of simple works,good reduction,fixed securely and better results,and so on.