胸腰段骨折伴脊髓损伤的手术治疗分析

Surgical treatment of thoracolumbar fracture with spinal cord injury

目的探讨胸腰段骨折伴脊髓损伤的治疗。方法胸腰段骨折伴脊髓损伤患者39例,全部均采用前路、后路及前后联合手术入路的方法行手术治疗。其中单节段受累35例,T_(11) 5例、T_(12) 15例、L_1 15例。双节断受累4例,T_(11)和T_(12) 3例、T_(12)和L_1 1例。Frankel分级:A级5例、B级14例、C级13例、D级7例。结果所有的脊髓均获得了充分的有效的减压,脊柱得到了良好的内固定,平均随访24个月,植骨处融合良好,有1例出现了脊柱后凸畸形,有2例出现椎弓根螺钉松动,伤椎由术前的(1.6±0.3)cm恢复到术后的(3.0±0.3)cm,Cobb角由术前的(27±2)°恢复到(40±3)°。Frankel分级A级4例、B级6例、C级19例、D级8例、E级2例。结论胸腰段骨折伴脊髓损伤的手术治疗中,前后路均为有效的方法,且各有优缺点。但前路手术可直接脊髓减压、复位内固定植骨融合,且融合率高,在脊柱的畸形矫正以及脊柱的稳定性重建方面为一种更为确切而且有效的方法。

Objective To study the methods of curing thoracolumbar fracture with spinal cord injury. Methods All the 39 patients subjected operation on the operative approach of anterior, posterior and combined approach. Single segment of which involved 35 cases, T11 5 cases, T12 15 cases, L1 15 cases. Double fault involved in 4 cases, TII and T12 3 cases, T12 L1 1 cases. Frankel grade： A grade 5 cases, B grade in 14 cases, C grade in 13 cases, D in 7 patients. Results All the spinal cord have received adequate and effective decompression, spinal fixation has been good, with an average follow - up of 24 months, good bone fusion department, appeared kyphosis in one case, had vertebral pedicle screw loose in two patients, injured vertebrae from the preoperative （ 1.6 ± 0.3 ） cm to a postoperative recovery （ 3.0 ± 0.3 ） cm, cobb angle from preoperative to （27 ± 2 ）° back to （40 ± 3 ） °. Frankel grade A in 4 cases, B grade in 6 cases, C grade in 19 cases, D grade in 8 eases,, E grade in 2 case. Conclusion Thoraeolumbar fractures with spinal cord injury off the surgical treatment, both anterior and effective way and the advantages and disadvantages. However, direct anterior spinal decompression, reduction and internal fixation and fusion, and fusion rate in spinal deformity correction and reconstruction of spinal stability is a more precise and effective method.