椎板开窗骨折复位治疗腰椎爆裂性骨折

Lamina Fenestration Reduction for Lumbar Burst Fracture

目的探索腰椎爆裂性骨折手术的新术式。方法设计并应用脊柱后路椎板开窗,通过打平器将骨块复位,探查椎管及神经根,完成椎管内减压,GSS钉棒系统固定,既最大程度的保留了后柱的稳定结构,又完成了椎管减压,术后1～2年取出钉棒系统,恢复腰椎的自然形态和功能,完成腰椎骨折的自然重建过程。结果术前Cobb角平均25.6°,椎管面积残余率平均79.1%,术后Cobb角平均5.4°,椎管面积残余率98.5%,与术前相比差异有统计学意义。结论后路椎板开窗,既能最大程度保留后柱结构,又能直接对骨折复位,完成椎管内减压,最终能够恢复腰椎的生理形态及功能,同时具有手术创伤小、出血少、操作简单、恢复快、并发症少等优点,此技术是治疗腰椎爆裂性骨折的一种可选择术式。

Objective To explore a new surgical procedure for lumbar burst fracture. Methods Based on the design and application of spinal posterior fenestration, a draw device was used to reset the bone fragments, detect the spinal canal and nerve roots and complete spinal canal decompression. And the GSS screw-rod system was fixed, which not only retained the greatest degree of post-column stable structure, but also completed spinal canal decompression, and after 1-2 years, the screw-rod system was drawn out, the natural lumbar spine shape and function were restored and the natural fracture reconstruction process was completed. Results The average preoperative Cobb angle was 25.6° and the average preoperative spinal canal area was 79.1%. The average postoperative Cobb angle was 5.4° and the average postoperative spinal canal area was 98.5% ,with a significant difference. Conclusion The lamina fenestration can retain the greatest degree of posterior column structures,reach the direct fracture reduction,complete decompression of spinal canal and eventually to restore the physiological shape and functions of the lumbar spine,with less surgical trauma,less bleeding,simple operation,quick recovery,fewer complications, etc, and therefore, this procedure is a surgical choice of the treatment of lumbar burst fracture.