胸腰椎爆裂骨折外科治疗策略

Analysis the surgical treatment of thoracolumbar burst fractures

目的探讨胸腰椎爆裂骨折外科治疗策略。方法采用胸腰椎后路椎弓根螺钉固定术治疗胸腰椎爆裂骨折36例,对比患者手术前后神经功能评价、影像学指标及自我满意率。结果平均随访42个月,Frankel评分平均提高1～2级;Cobb角由术前平均23°恢复至2.3°;椎体前后缘高度分别由术前平均37.5%(12.0%～46.0%)和79.0%(31.0%～87.0%)恢复到术后平均92.5%(90.0%～100%)和97.4%(94.5%～99.8%),18例术后CT扫描椎管内占位分别由61%恢复至32%;术后优良率(自我满意率)为88%。结论手术治疗可使患者尽早恢复日常生活,有效恢复脊柱序列及椎管容积、矫正后凸畸形,有利于胸腰椎功能的恢复。

Objective To evaluate the strategy of surgical management for thoracolumbar burst fractures.Methods 36 cases of thoracolumbar burst fractures were treated with pedical screw system through posterior approach.Frankel scores and Cobb angles on X-rays before and after operation were evaluated and compared.Spinal canal encroachment were compared on preperative and postoperative computed tomography（CT）scans.Results The mean follow-up period was 42 months.Frankel scores improved 1~2 grades on average.The mean Cobb angle restored from 23 degrees preoperatively to 2.3 degrees postoperatively.The mean heights of anterior and posterior edge of centrums restored respectively from 37.5%（12.0%~46.0%）and 79.0%（31.0%~87.0%）preoperatively to 92.5%（90.0%~100%）and 97.4%（94.5%~99.8%） postoperatively.The mean spinal canal encroachment from 61% to 32% by CT scans in 18 cases.Neurological function improved in all cases,and the satisfactory rate was 88%.Conclusion Surgical treatment is effective to thoracolumbar burst fractures,which can help patients recover their daily lives earlier,effectively restore the alignment and volume of spinal canal and correct the kyphosis for the recovery of thoracolumbar function.