经后路椎体次全切除加椎间支撑植骨治疗胸腰椎爆裂性骨折及骨折脱位的早期疗效观察

SUBTOTAL CORPECTOMY AND INTERVERTEBRAL BONE GRAFTING THROUGH POSTERIOR APPROACH ALONE IN TREATMENT OF THORACOLUMBAR BURST FRACTURE OR THORACOLUMBAR FRACTURE-DISLOCATION

目的探讨经后路椎体次全切除加椎间支撑植骨治疗胸腰椎爆裂性骨折及骨折脱位的早期临床疗效。方法 2009年1月-2010年12月,采用经后路椎体次全切除加椎间支撑植骨治疗胸腰椎爆裂性骨折及骨折脱位20例。其中男14例,女6例;年龄19～47岁,平均36.1岁。致伤原因:高处坠落伤12例,交通事故伤6例,重物砸伤2例。骨折按照AO分型:A3型10例,B2型8例,C2型2例。单节段损伤8例,双节段损伤12例。合并骨折脱位12例,侧方移位6例,患者椎管内骨性占位明显。术前Cobb角(30.2±3.9)°。Frankel神经功能分级:B级4例,C级9例,D级7例。受伤至手术时间1～12 d,平均4.5 d。结果手术切口均Ⅰ期愈合,无切口感染。20例均获随访,随访时间8～16个月,平均12个月。植骨均骨性愈合,愈合时间6～9个月,平均7个月。末次随访时Frankel神经功能分级均较术前恢复1～3级,其中C级1例、D级2例、E级17例。末次随访时Cobb角为(6.5±4.2)°,与术前比较差异有统计学意义(t=2.39,P=0.00)。无断钉、断棒、螺钉松动、椎体间支撑内植物下沉等并发症发生。结论经后路椎体次全切除加椎间支撑植骨可以很好进行椎管内减压,恢复脊柱稳定性,植骨愈合率高,神经功能恢复良好;但术中出血相对较多,对术者技术要求较高。

Objective To evaluate the early clinical outcomes of subtotal corpectomy and intervertebral bone grafting through posterior approach alone in the treatment of thoracolumbar burst fracture or thoracolumbar fracture- dislocation. Methods Between January 2009 and December 2010, 20 patients with thoracolumbar burst fracture or thoracolumbar fracture dislocation were treated with subtotal corpectomy and intervertebral bone grafting through posterior approach alone. There were 14 males and 6 females, with an average age of 36.1 years （range, 19-47 years）. Fractures were causedby falling from height in 12 cases, traffic accident in 6 cases, and crushing in 2 cases. According to AO classification, there were 10 cases of A3 type, 8 cases of B2 type, and 2 cases of C2 type. Single segment was involved in 8 cases, double segments in 12 cases. Twelve cases complicated by fracture dislocation and 6 cases by lateral displacement. All patients had bones occupancy in vertebral canal. The preoperative Cobb angle was （30.2 ± 3.9）°. According to Frankel classification for neurological function, there were 4 cases of grade B, 9 cases of grade C, and 7 cases of grade D at preoperation. The mean time between injury and operation was 4.5 days （range, 1-12 days）. Results All incisions healed by first intention, and no infection occurred. Twenty patients were followed up 8-16 months （mean, 12 months）. The interbody fusion time was 6-9 months （mean, 7 months）. Neurological function recovered 1 to 3 grades： l case of grade C, 2 cases of grade D, 17 cases of grade E at last follow-up. The Cobb angle was （6.5 ± 4.2）° at last follow-up, showing significant difference when compared with preoperative value （t=-2.39, P=0.00）. No breaking or loosening of screw and implant sinkage occurred. Conclusion A combination of subtotal corpectomy and intervertebral bone grafting through posterior approach alone has the advantages of complete decompression, restoration of spinal stability, restoration of vertebral body height, high bone healing rate, and good recovery of neurological function. However, this surgical technique has a relatively large amount of blood loss and high requirements for surgeons.