后路半椎板减压钉棒系统固定治疗胸腰段骨折

Posterior semilaminectomy and screw-rod system fixation for thoracolumbar fractures

目的探讨后路单侧半椎板切除减压、对侧椎板植骨、钉棒系统固定治疗胸腰段骨折临床疗效。方法对62例患者进行X线和CT检查,测定术前术后伤椎前缘高度、Cobb角,按Frankel脊髓损伤分级进行术前术后比较。采用视觉模拟评分法(VAS)及腰椎功能障碍指数(ODI)评定手术后的疗效。结果患者椎体前缘高度由术前(48±3)%恢复至(89±5)%,椎体后缘(中柱)高度由术前(57±2)%恢复至(97±6)%,Cobb角由术前(21.6±2)°恢复至(9.3±3)°。62例均获随访,时间6个月～4年。神经功能恢复按Frankel分级:A级12例恢复至B级2例,10例无明显变化;B级25例恢复至D级12例、C级13例;C级18例均恢复至D级;D级7例均恢复至E级。手术前后的VAS及ODI分值改变比较差异有统计学意义(P<0.01)。结论后路半椎板切除减压、对侧椎板植骨、钉棒系统固定治疗胸腰段骨折疗效满意。

Objective To investigate the clinical efficacy of posterior decompression semilaminectomy,contralateral lamina bone graft,screw-rod system fixation for the treatment of thoracolumbar fractures.Methods 62 cases were enrotlled.Preoperative and postoperative X-ray and CT were measured before and after surgery on anterior edge height of vertebral injury,Cobb′s angle,and Frankel grading of spinal cord injury.Visual analog scale（VAS） and Oswestry disability index（ODI） were used in assessment of the efficacy.Results The anterior vertebral height were restored from（48±3）% to（89±5）%,posterior height from（57±2）% to（97±6）%,Cobb angle from（21.6±2）°to（9.3±3） °.62 patients were followed up for 6 months to 4 years.The neural function recovery was evaluated by Frankle system.In 12 cases of grade A,2 patients recovered to grade B,10 cases remained unchanged;In 25 cases of grade B,12 cases recovered to D,13 to C;18 cases of grade C were returned to D grade;7 cases of grade D returned to E level.Perioperative changes in VAS and ODI scores was statistically significant difference（P〈0.01）.Conclusions Posterior decompression semilaminectomy,contralateral laminar bone graft and screw-rod system fixation are effective for thoracolumbar fracture.