经椎弓根椎管前方减压治疗胸腰椎爆裂骨折

Broken-bone Excision,Decompression and Reconstruction of Spine in the Treatment of thoracolumbar Burst fracture through Pedicleectomy Posterior Approach

目的探讨后路经椎弓根椎管前方骨块切除减压重建治疗胸腰椎爆裂骨折的临床疗效。方法 2007年6月至2009年5月采用后路经椎弓根椎管前方骨块切除减压重建治疗胸腰椎爆裂骨折26例(20例获得随访,6例失访)。高空坠落伤8例,车祸伤10例,重物压砸伤2例。T113例,T127例,L18例,L22例。采用A S IA分级进行神经功能评估。通过术前、术后1周、术后6个月随访时的X线及CT片比较椎管容积及Cobb角变化,评估椎管减压及复位情况。结果手术时间2.3～3.5 h,平均2.8 h,术中出血500～1 800 mL,平均700 mL,术中无神经及血管进一步损伤,术后无感染及深静脉血栓等并发症。20例患者得到随访,平均随访18个月(12～24个月)。椎管容积(CT测量实际椎管容积占正常椎管容积的百分比)术前平均53.23%,术后1周95.17%,术后6个月96.47%,与术前比较明显改善(P<0.05);Cobb角术前平均20.6,°术后1周4.3,°术后6个月4.9,°与术前比较明显改善(P<0.05)。所有病例脊髓获得有效减压,A S IA分级改善1级者10例,改善2级者7例,2例无明显改善者术前均为A级,1例术前为E级者术后仍为E级。所有病例术后6个月植骨均达骨性愈合,内固定未见松动、断裂。结论后路经椎弓根椎管前方骨块切除减压重建治疗胸腰椎爆裂骨折可以有效恢复椎管容积及Cobb角度,是安全、有效的手术方法。

Objective To explore the effect of broken-bone excision,decompression and reconstruction of spine in the treatment of thoracolumbar burst fracture through pedicleectomy posterior approach.Methods From June 2007 to May 2009,26 patients with thoracolumbar burst fractures were treated with broken-bone excision,decompression and reconstruction of spine through pedicleectomy posterior approach.Twenty patients were followed up and six patients were missed.The injury causes included falling down in 8 cases,traffic accident in 10 cases and crushing in 2 cases.T11 was involved in 3 cases,T12 in 7cases,L1 in 8 cases,L2 in 2 cases.Neurological status at preoperative,1 week postoperative and 6 month postoperative were reviews by ASIA scoring system,the decompression and reduction status were reviewed radiologically.Results The average operation time was 2.8 h（ranging,2.3 to 3.5）,and the average hemorrhage was 700mL（ranging,500 to 1800mL）.No nerve and blood vessel injury.The average follow-up period was 18 months（ranging,12～24 months）.The volume rate of spinal canal involved（the actual spinal canal volume under cross-section/normal spinal canal volume） increase from 53.23% preoperatively to 95.17% 1 week postoperatively and 96.47% 6 months postoperatively（P0.05）.The Cobb-angle decrease from 26.6°preoperatively to 4.3° 1 week postoperatively and 4.9° 6 month postoperatively（P0.05）.All patients had complete bony fusion at 6 months postoperatively without occurrence of implant failure.All patients had neurofunctional recovery 1～2 Grade,except that two A Grade patients preoperatively and one E Grade patient preoperatively had no improvement.Conclusion Treatment of thoracolumbar burst fractures by broken-bone excision,decompression and reconstruction of spine through pedicleectomy posterior approach are safe and effective in reconstructing spinal canal volume and Cobb-angle.