气管插管球囊扩张术在严重开放性胸腰椎骨折治疗中的作用

Treatment of severe thoracolumbar fractures with open surgery and balloon inflation of the endotracheal tube

目的 探讨气管插管球囊扩张术在严重开放性胸腰椎骨折治疗中的作用.方法 2007年1月至2010年1月对26例（28椎）严重胸腰椎骨折先行脊柱内固定器系统固定,后经椎弓根气管插管球囊扩张、椎体内植入自体骨泥及颗粒骨.21例为新鲜骨折,5例为陈旧性骨折.损伤节段：T10 1例,T11 2例,T12 6例,L1 10例,L2例,L4 5例,L5 2例.24例为单椎损伤,2例为双椎损伤（T12、L1及L1、L5）.术前Frankel分级：B级2例,C级4例,D级3例,E级17例.17例（18椎）为压缩性骨折,9例（10椎）为爆裂骨折.结果 本组术中无脊髓、神经损伤等并发症发生.出血量为50～500 mL,平均120 mL;手术时间为120～210 min,平均140 min.术后住院时间为10～20 d,平均13 d.26例患者术后获3～30个月（平均15个月）随访.椎体高度和生理弧度恢复满意,无内固定松动、断裂发生.Cobb角由术前32.3°±3.3°恢复至术后1.3°±0.5°,并维持稳定无变小.椎体前后缘高度比值由术前33.1%±5.3%恢复至术后99.6%±0.3%.疼痛视觉模拟法评分由术前（6.5±1.0）分恢复至术后（0.9±0.7）分.9例（10椎）爆裂性骨折椎管横截面积侵占率术前平均为60%（30%～80%）,术后平均为1%（0～10%）,复位率达90%.9例脊髓损伤患者术后恢复至Frankel分级D级2例,E级7例,较术前改善1～2级.结论 气管插管球囊扩张、经椎弓根伤椎内骨泥、颗粒骨混合植骨联合椎弓根钉系统治疗严重胸腰椎压缩或爆裂骨折,手术安全,效果满意.

Objective To evaluate the treatment of severe thoracolumbar fractures with open operation and balloon inflation of the endotracheal tube. Methods From January 2007 to January 2010, 26 cases of severe compressed thoracolumbar fractures were treated with transpedicular fixation of the spinal system, balloon inflation of the endotracheal tube and transpedicular structural and cancellous bone granule graft into the compressed vertebral body. There were 21 fresh fractures and 5 old ones. The fractures occurred at levels T10 （n=1）, T11 （n=2）, T12 （n=6）, L1 （n=10）, L2 （n=2）, L4 （n=5）, and L5 （n=2）. Injury involved a single vertebra in 24 cases and double vertebral bodies in 2 cases of injury （T12 and L1;L1 and L5）. Preoperative Frankel grading showed Frankel B in 2, Frankel C in 4, Frankel D in 3, and Frankel E in 17 cases. 17 patients （18 vertebrae） presented with a compressed fracture and 9 patients （10 vertebrae） with a burst fracture. Results The operative blood loss ranged from 50 to 500 mL, averaging 120 mL. The surgery time was 120 to 210 minutes, averaging 140 minutes. The hospital stay was 10 to 20 days, averaging 13 days. A mean follow-up of 15 months （3 to 30 months） revealed fracture union, no spinal cord injury or nerve injury, restoration of the compressed vertebral height and natural curve of the spinal column, and no loosening or disrupted internal fixation in this group. The average Cobb angle decreased from 32. 3°± 3. 3°preoperatively to 1.3°± 0. 5° postoperatively. The ratio of anterior to posterior vertebral body height improved from 33. 1% ±5.3% preoperatively to 99.6% ±0.3% postoperatively. The VAS score decreased from 6. 5 ± 0. 99 preoperatively to 0. 88 ± 0. 71 postoperatively. The average occupation rate of spinal canal area in 9 patients （10 vertebrae） with burst fracture decreased from 60% （30% to 80% ） preoperatively to 1% （0 to 10% ） postoperatively, with an average reduction of 90%. Nine patients with spinal injury experienced a significant improvement of 1 to 2 Frankel grades, reaching Frankel D （n = 2） and Frankel E （n = 7） .Conclusions Balloon inflation of the endotracheal tube enhances the effects of transpedicular structural and cancellous bone granule graft and transpedicular fixation for severe thoracolumbar fractures, no matter fresh or old, compressed or burst, and moreover it is safe and inexpensive.