一期前后联合入路治疗胸腰椎严重爆裂骨折

Combined anterior and posterior approach to treat severe thoracolumbar burst fracture

目的探讨一期前后联合入路、后路固定、前路减压内固定治疗胸腰椎爆裂骨折合并脊髓及神经损伤患者的临床疗效。方法回顾一期前后联合入路、后路固定、前路减压内固定治疗的10例胸腰椎爆裂骨折合并脊髓及神经损伤,并分析一期前后联合手术的优缺点、适应证及内固定方法。结果本组10例椎管均获得有效减压,平均随访14个月,植骨块融合良好,伤椎高度基本恢复,Cobb’s角由术前平均17°恢复到5°,Frankel分级恢复1级者4例,恢复2级者3例,无变化者3例。结论一期前后联合入路、后路固定、前路减压内固定术是集减压、复位、内固定、植骨融合一次完成的有效方法,可矫正畸形、重建脊柱稳定,但由于手术创伤较大,出血较多,应严格掌握手术指征。

Objective To discuss the effect of posterior fixation combined with anterior decompression and internal fixation for the treatment of thoracolumbar burst fracture with spinal cord and nerve injury.Methods Ten patients of thoracolumbar burst fracture combined with spinal cord and nerve injury were treated with combined anterior and posterior approach,and the advantages,disadvantages,indications and internal fixation method of the combined approach were analyzed.Results All patients achieved good spinal canal decompression,with an average follow-up time of 2.5 years.All patients got good bone fusion and regained the injured vertebral height.Cobb＇s angle restored to 5 degree（averaging 17 degree preoperatively）.According to Frankel scale system,4 cases restored to Grade A,3 cases Grade B,no change in 3 cases.Conclusion The combined anterior and posterior approach has functions of decompression,reduction,internal fixation,bone fusion,deformity correction,reconstruction of spinal stability,with disadvantages of extensive surgical trauma and bleeding.So surgical indications should be strictly controlled.