椎弓根钉固定椎体次全切钛网重建治疗腰椎爆裂骨折

Pedicle Screw Internal Fixation Plus Subtotal Vertebrectomy and Titanium Cage Reconstruction of Spine in the Treatment of Lumbar Burst Fractures

目的探讨经后路椎弓根钉固定,椎管减压加椎体次全切钛网重建治疗腰椎爆裂骨折的疗效及预后。方法 2008年1月至2010年1月,采用一期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固定后柱治疗腰椎爆裂骨折18例,其中男13例,女5例;年龄20～55岁,平均38.6岁。均为单椎体爆裂骨折,L13例,L27例,L36例,L41例,L51例。采用美国脊柱损伤学会分级进行神经功能评估。通过X线和CT评估手术前后及末次随访时伤椎椎体高度、椎管内径及骨融合情况。结果手术均顺利完成,手术时间2.5～4.5h,平均3.7h。出血量680～1 500mL,平均980mL。术后发生脑脊液漏3例,无其他严重并发症发生。所有病例均获随访,时间12～36个月,平均25个月,内固定无松动、断裂,钛网重建节段获得骨性融合,椎体的高度、曲度和椎管容积无明显丢失,无感染及医源性神经损伤等并发症。除1例A级患者外,其他患者神经功能均有不同程度的恢复。结论经后路椎弓根钉固定加椎体次全切重建脊柱三柱稳定性手术具有手术操作相对简便、创伤小、脊髓减压彻底、脊柱前中后柱即刻稳定、并发症少等特点,是腰椎爆裂骨折的一种有效治疗方法。

Objective To evaluate the efficacy and prognosis of treating lumbar burst fracture by subtotal resection of vertebral body,implantation of titanium cage and fixation with pedicle screw through posterior approach.Methods From January 2008 to January 2010,18 patients with burst lumbar fracture were treated by posterior subtotal resection of vertebral body,implantation of titanium cage and pedicle screw internal fixation.The patients included 13 males and 5 females,with an average age of 38.6 years old（20～55 years old）.L1 was involved in 3 cases,L2 in 7 cases,L3 in 6 cases,L4 in 1 case and L5 in 1 case.Neurological status at preoperative,postoperative and final follow-up were reviewed by ASIA scoring system,the reduction and fusion status were reviewed radiologically.Results The average operation time was 3.7 h（ranging 2.5 to 4.5 h）,and the average hemorrhage was 980 mL（680 to 1 500 mL）.Cerebrospinal fluid leakage occurred in 3 patients,no blood vessel and nerve injury,no infection occurred.The average follow up was 25 months（12 to 36 months）.All patients had complete bony fusion at final follow-up,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 one patient who had the nervous function of grade A.Conclusion Treatment of lumbar burst fractures by subtotal resection of vertebral body,implantation of titanium cage and fixation with pedicle screw through posterior approach has the advantages of less injury,thorough spinal cord decompression,prompt postoperative three-column stability of spine.It is an ideal operation method for the treatment of lumbar burst fractures.