后路切开复位内固定治疗胸腰椎爆裂型骨折

Treatment of thoracolumbar burst fracture with posterior open reduction internal fixation

目的探讨经后路切开复位短节段椎弓根内固定治疗胸腰椎爆裂型骨折的可行性和实效性。方法 2004年1月至2008年12月,采用单纯后路切开复位、椎弓根螺钉系统内固定治疗胸、腰椎爆裂型骨折共48例。所有患者术前CT检查示椎管占位率均>50%,但无明显脊髓损伤的临床表现。通过影像学及社会功能来综合评估疗效。结果术后Cobb’s角平均降低17.9°,椎体平均高度接近正常的90.4%,椎管占位平均<10.9%。平均随访25(12～31)个月,骨折愈合良好,所有患者恢复日常生活能力,绝大多数患者恢复工作能力。结论后路切开复位内固定治疗无明显神经症状的胸腰椎爆裂型骨折患者,无需减压即可有效恢复椎体高度、Cobb’s角和椎管容积,是临床治疗此类骨折的首选方案。

Objective To study the feasibility and effectiveness of simple posterior open reduction internal fixation（ORIF） in treating thoracolumbar burst fracture. Methods From Jan.2004 to Dec.2008,forty-eight cases of thoracolumbar burst fracture were treated by applying simple posterior open reduction and pedicle screw spinal system.Canal compromise revealed on CT scans of all patients exceeded 50% before operation but with few symptom of SCI.Results Cobb＇s angle was reduced by 17.9 ° in average,vertebral body height nearly normal 90.4% and canal compromise no more than 10.9%.After operation,followed up of all cases to 25 months（12-31 months）in average showed healed well and recovery of living ability.Most of them continued their normal work.Conclusion Treating thoracolumbar burst fracture with few symptoms of SCI by simple posterior ORIF can restore vertebral height,Cobb＇s angle and canal compromise without need for further decompression.The operation duration and bleeding volume were comparatively shorter and less than the traditional decompression operation.Therefore it should be the optimum choice for treating such fractures.