后路椎板减压椎弓根螺钉固定结合经伤椎椎弓根植骨治疗腰椎爆裂骨折伴不完全截瘫

Surgical Treatment of Lumbar Burst Fractures with Incomplete Paraplegia by Posterior Fenestration of Vertebral Plate,Pedicle Screw Fixationg and Transpedicular Bone Grafting

目的:探讨后路椎板减压椎弓根螺钉固定结合经伤椎椎弓根植骨治疗腰椎爆裂骨折伴不完全截瘫的疗效。方法:2006年4月至2008年12月收治腰椎爆裂骨折伴不完全截瘫患者22例,均采用后路椎板减压、椎弓根螺钉固定、伤椎直接锤顶复位、经伤椎椎弓根植骨治疗,随访椎体高度、Cobb角、椎管减压和神经功能恢复情况。结果:术中定位准确,未出现螺钉进入椎管,手术时间(100～150)分钟,平均135分钟,术中出血量(300～800)ml,平均70 ml。术后切口均Ⅰ/甲愈合,21例得到随访,随访时间(7～12)个月,平均10.5个月,所有患者椎体前缘高度由术前平均42.6%矫正到术后平均97.2%,脊柱后凸Cobb角由术前平均32.6。矫正到术后平均3.5。,伤椎椎管正中矢状径由术前平均48%矫正到术后平均94%,髓访未见椎体高度明显丢失及Cobb角明显增大,椎管减压维持良好,神经功能Frankel分级有1～3级恢复。结论:后路椎板减压椎弓根螺钉固定结合经伤椎椎弓根植骨治疗腰椎爆裂骨折伴不完全截瘫可同时解决脊髓减压和脊柱稳定问题,具有良好的治疗效果。

Objective： To study the effect of posterior fenestration of vertabral plate,internal fixation with pedicle screw instrumentation and transpedicular bone grafting for lumbar burst fractures with incomplete paraplegia.Methods： 22 patients of lumbar burst fractures with incomplete paraplegia who were under posterior decompression of vertebral plate,internal fixation with pedicle instrumentation,stamping vertebra and transpedicular bone grafting were analyzed retrospetively between April 2006 and december 2008.There were 14 males,8females,aged from （16-48）.Results： 21cases were followed up from 7 to 12months,10.5 months on an average..Anterior border height of compressed vertebral bodies was restored from preoperative 42.6% to preoperative 97.2%.Posterior angulation was corrected from preoperative 32.6. to opostoperative 3.5 .According to Frankel ranking for paralysis recovery, all the cases had improved about 1 to 3 grade.The height of vertebral bodies was not lost and the angulation of spinal column was not aggravated either.Conclusion： The treatment by posterior fenestration of vertebral plate ,internal fixation with pedicle screw and transpedicular bone grafting can solve the problem of both spinal cord decompression and spine stability for lumbar burst fracture with incomplete paraplegia.It,s safe and effective for clinical cases.