小切口腹膜外入路手术治疗下腰椎骨折初步探讨

Surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach

目的 评价小切口腹膜外入路手术治疗下腰椎爆裂性骨折的疗效,并探讨手术技巧.方法 回顾性分析小切口腹膜外入路手术治疗的21例严重下腰椎爆裂性骨折病例.男15例,女6例;年龄19～65岁,平均35.9岁.L3 10例,L4 8例,L5 3例.按照Magerl分型（AO分型）：A类（爆裂型）12例,B类（分离型）2例,C类（扭转型）7例.所有病例均行小切口腹膜外入路伤椎部分切除减压、植骨融合及内固定.分别比较术前与术后即刻的影像学指标变化,及术前与术后末次随访时神经功能（ASIA分级）的变化.结果 术后平均随访41.9个月（12～86个月）.术后即刻影像学资料显示：伤椎椎体前缘高度由术前平均42.62％±10.32％恢复至94.33％±5.23％（P＜0.01）,椎管受堵指数由术前平均2.67±0.86恢复至0.14±0.36（P＜0.01）.除1例L3、T11骨折并完全截瘫者外,余有神经损伤者在术后末次随访时均出现一级以上的恢复.随访期间内固定无松动、断裂等发生.结论 对于严重下腰椎爆裂性骨折,采用小切口腹膜外入路进行减压和固定,具有创伤小、神经功能恢复良好的效果.

Objective To investigate the clinical effects of surgical treatment of lower lumbar fracture with mini-incision via retroperitoneal anterior approach. Methods The data of 21 cases with serious lower lumbar burst fracture were analyzed retrospectively. There were 15 males and 6 females with an average age of 35.9 years （ranged, 19-65 years）. The lesion was located in L3 in 10 cases, L4 in 8 and L5 in 3cases. According to Magerl classification, there was type A （burst in 12 cases, type B （distraction） in 2 and type C （retortion） in 7 cases. All the 21 cases were treated with anterior decompression, bone graft fusion and internal fixation with mini-incision via retroperitoneal anterior approach. The changes of radiograph and neurologic status were recorded respectively. Results All the cases had been followed up for an average of 41.9 months （12-86 months）. The radiograph showed obvious improvement on the injured body height （from 42.62% preoperatively to 94.33% postoperatively, P〈0.01） and the canal encroachment index （from 2.67 preoperatively to 0.14 postoperatively, P〈0.01）. Significant improvement in neurological function were achieved in all patients with the improvement of one grade except for 1 case with L3, T11 fracture and complete paraplegia. No failure of implants was found during the follow-up period. Conclusion Anterior decompression and internal fixation with mini-incision via retroperitoneal anterior approach are successful in treating serious lower lumbar burst fractures.