胸腰椎骨折全椎板切除后重建脊柱后柱稳定的临床研究

Reconstruction of spinal posterior column stability after total laminectomy for thoracolumbar fractures

目的探讨采用同种异体皮质骨板联合自体骨移植的方法对胸腰椎骨折全椎板切除后重建脊柱后柱稳定的效果。方法 2006年12月至2008年6月我院治疗胸腰椎骨折34例,均采用后路手术,安放椎弓根系统复位、固定后,伤椎全椎板减压,探察椎管,处理损伤的脊髓或马尾后,根据术中情况将骨板修剪成"H"型,卡压在减压的椎管后侧和正常棘突之间,异体骨板后侧植入全椎板切除得到的自体骨。结果全组病例随访14-31个月,平均18.7个月,所有病例减压的椎管得到有效的封闭,植骨得到良好的愈合,后路稳定性得到重建,内固定无折裂。拆除内固定物时发现侧位Cobb's角平均丢失约1.7°,椎体前、后缘高度平均丢失分别约为3.6%和1.5%。结论该方法有效地提供后路稳定,防止内固定失败,促进神经恢复。

Objective To investigate the effect of using cortical allograft bone plate and autologous bone transplantation to reconstruct the posterior column stability after total laminectomy thoracolumbar fractures. Methods From December 2006 to June 2008, 34 cases of thoraeolumbar fractures were treated in our hospital. All cases underwent all procedures with posterior approach, including internal ftxaiton with pedicle screw system and omniposterior decompression. We checked the condition of the spinal canal, and treated the injury of the spine or cauda equian, and cut the allograft bone plate into ＇H＇ shape according to the patient＇s condition. The plate was placed the back of the decompressed canal and the normal process. The autologous bone obtained during the surgery was implanted behind the allograft bone. Results All eases were followed up between 14 to 31 months, 18.7 months on average. All cases achieved effective closure of the spinal canal. Posterior bone-graft healed well, the posterior stability was restored, and no internal fixation failure occured. The average loss of lateral Cobb＇s angle, anterior vertebral edge height, posterior vertebral edge height were 1.7°, 3.6% and 1.5%, respectively. Conclusions The procedure is effective for restoring stability of the posterior column, and preventing the failure of internal fixation as to promote nerve injury recovery.