后路椎弓根螺钉固定加椎体切除减压钛网重建治疗严重下腰椎骨折疗效分析

Effective analysis of the posterior vertebral pedicle screw fixation,vertebral body removal,decompression and titanium mesh reconstruction for the treatment of the lower lumbar fractures

目的:评价经后路椎弓根螺钉固定,椎管减压,钛网重建椎体治疗严重下腰椎骨折的疗效。方法:2006年1月至2008年12月收治22例严重下腰椎爆裂性骨折患者,男18例,女4例;年龄22～63岁,平均43.8岁。L3 11例,L4 8例,L5 3例。行I期后路椎弓根螺钉固定椎体切除减压钛网重建,统计手术时间、术中出血量、手术前后的伤椎高度、伤椎矢状位指数(SI)、腰椎前凸角等影像学指标变化,采用下腰痛疗效评分法评价疗效。结果:手术时间3～4.2 h,平均3.6 h;出血量900～1 500 ml,平均1 300 ml;矢状位指数术前(57.5±7.6)%,术后(93.5±8.1)%;腰椎前凸角术前(34.3±7.3)°,术后(38.5±9.8)°。22例患者随访10个月～3年,平均2.6年,无内固定失败者,钛网重建节段骨性融合,无假关节形成。15例神经损伤患者末次随访Frankel分级:E级10例,D级4例,C级1例;依据下腰痛评分结果分级,优20例,良1例,可1例。结论:Ⅰ期经腰椎后路椎弓根螺钉固定,椎管减压、椎体切除联合钛网植骨融合重建椎体手术创伤小,可进行彻底的椎管减压和神经根减压;同时可以选择长度合适的钛网,恢复腰椎前凸,可有效重建下腰椎的稳定性;有效防止迟发性神经损害、腰椎后凸畸形及慢性腰痛,可达到较满意的治疗效果。

Objective：To evaluate the effect of the treatment of the lower lumbar fractures by posterior vertebral pedicle screw fixation,vertebral canal decompression,bone graft and titanium mesh reconstruction.Methods：From January 2006 to December 2008,22 patients with lower lumbar fractures were treated by posterior vertebral pedicle screw fixation,vertebral canal decompression,bone graft and titanium mesh reconstruction at same period.There were 18 males and 4 females with an average age of 43.8 years ranging from 22 to 63 years old.The injured vertebrae were L3 in 11 cases,L4 in 8 cases,and L5 in 3 cases.The operative time,blood loss,the preoperative and postoperative vertebral height,sagittal index,and the lumbar lordo-sis angle were recorded and evaluated.Results：The operative time was 3 to 4.2 hours（means 3.6 h）.The blood loss averaged 1 300 ml（900 to 1 500 ml）.The preoperative and postoperative sagittal index were（57.5±7.6）% and（93.5±8.1）%,respectively.The preoperative and postoperative lumbar lordosis angle were（34.3±7.3）° and（38.5±9.8）°,respectively.All patients were followed up for 10 months to 3 years（means 2.6 years）.No fixation were failed,the segment of titanium mesh reconstruction obtained bone healing,no pseudoarticulation formation.At the last time of followed up,15 patients with nerve injuries were e-valuated according to Frankel grade,there were 10 cases in grade E,4 in D,1 in C.According to the low back outcome scores（LBOS）,the results were excellent in 20 cases,good in 1,fair in 1.Conclusion：The stability of the lower lumbar spine can be reconstructed by bone graft and titanium mesh combined with transpedicular screw fixation through a posterior approach.The decompression and vertebral body removal can also be performed in this approach.The recovery of the vertebral height and lumbar lordosis can prevent the delayed neurological deficit and traumatic kyphosis.