后路经椎弓根切除椎体三柱重建技术在胸腰椎爆裂性骨折的临床应用和疗效分析

After Resection of the Vertebral PedicleSpent Three Pillars Reconstruction Technique in Thoracolumbar Burst Fracture of Clinical Application and Effect Analysis

目的:探索创伤小、脊髓减压彻底、术后脊柱三柱即刻稳定、患者可早期活动的治疗胸腰椎爆裂性骨折的手术方案。方法:21例胸腰椎爆裂骨折患者,经后路单侧行椎体次全切除、脊髓环形减压、钛网支撑植骨重建前中柱及椎弓根钉后柱内固定。采用美国脊柱损伤学会(ASIA)分级进行神经功能评估,通过X线及CT片评估骨折复位、减压及骨融合情况。结果:手术均顺利完成,平均手术时间3.1 h;平均出血量1180 mL。术后发生脑脊液漏2例,无其他严重并发症发生。随访患者植骨融合,内固定无松动、断裂,椎体高度、曲度和椎管容积无明显丢失。除A级患者外,其他各级患者神经功能均有不同程度的恢复。结论:后路单侧椎体减压重建脊柱三柱稳定性手术具有创伤小、脊髓减压彻底、脊柱前中后柱即刻稳定等特点,可有效恢复椎体高度、脊柱的生理曲度、椎管容积和脊柱即刻稳定性,是治疗胸腰椎爆裂骨折的理想手术方式。

Objective：To explore an operation method with less injury,thorough spinal cord decompression,prompt post-operative three-column stability of spine and early movement for patients with thoracolumbar burst fractures in high altitude.Methods：Totally 21 patients with thoracolumbar burst fractures accepted posterior unilateral subtotal corpectomy,annular decompression of spinal cord,titanium mesh bone graft for reconstruction of anterior and middle column combined with pedicle instruments fixation.Spinal cord injury was evaluated with ASIA grade criterion.Reduction,decompression and fusion of fractures were evaluated through X-ray and computer tomography.Results：All operations were completed successfully.The mean operation time was 3.1 hours and the mean blood loss was 1180ml.Cerebrospinal fluid leakage occurred in 2 patients.No other severe complications were observed.Bone graft fusion was observed in follow-up patients.No looseness and rupture of internal fixation,no obvious loss of vertebral height,spinal radian and vertebral canal volume were observed.Nervous function improved in different degree in all patients except those who had the nervous function of grade A.Conclusion：The operation of posterior unilateral subtotal corpectomy and reconstruction of spinal three-column stability has the advantages of less injury,thorough pinal cord decompression,prompt post-operative three-column stability of spine,and can effectively restore vertebral height,vertebral canal volume,physiological radian and prompt stability of spine.It is an ideal operation method for the treatment of thoracolumbar burst fractures.