后路部分椎体切除三柱重建技术治疗单节段严重腰椎暴裂性骨折脱位

Partial Vertebrectomy with Three Columns Reconstruction of Spine Through Posterior Approach for the Treatment of Severe Single-segment Lumbar Burst Fracture and Dislocation

【目的】探讨后路部分椎体切除三柱重建技术治疗单节段严重腰椎暴裂性骨折脱住并神经损伤的临床疗效。【方法】9例严重腰椎暴裂骨折脱位患者，完成经后路椎管环形减压、椎弓根钉后柱内固定、椎体部分切除及钛网支撑植骨重建前中柱。采用美国脊柱损伤学会（ASIA）分级进行神经功能评估。比较手术前后ASIA评分和分级变化。术前、术后1个月时伤椎前缘高度变化。【结果】手术均顺利完成，平均手术时间3．2h；平均出血量660mL。除1例A级外，其余患者神经功能均有不同程度的恢复，手术前后ASIA评分及椎体前缘高度有统计学差异（P〈0．05）。术后所有患者均发生脑脊液漏，无其它严重并发症发生。【结论】经后路部分椎体切除三柱重建技术治疗单节段严重腰椎暴裂性骨折脱位具有对椎管减压彻底、术后脊柱三柱即刻稳定、手术创伤较小等特点，是治疗严重腰椎暴裂骨折脱位的安全、可靠的手术方式。

[Objective]To explore the clinical efficacy of partial vertebrectomy with three columns recon- struction of spine through posterior approach for the treatment of severe single-segment lumbar burst fracture and dislocation with nervous injury. [Methods] Nine patients with severe lumbar burst fracture and dislocation underwent ring decompression of spinal canal through posterior approach, pedicle screw internal fixation of posterior column, partial vertebrectomy and anterior-middle column reconstruction with titanium net prop graft. American spinal injury association（ASIA） grade was used for assessing the nervous function. The chan- ges of ASIA score and grade were compared between before and after operation. The changes of the height of anterior edge of injury vertebra before and a month after operation were also compared. [Results] All opera- tions were completed successfully. The mean operation time was 3. 2 hours and the mean blood loss was 660ml. Except a patient with grade A, the other patients＇ nervous function was improved in different degree. There was significantly different in ASIA score and the height of anterior edge of the injury vertebra between before and after operation（ P 〈0.05）. Cerebrospinal fluid leakage occurred in all patients. No other severe complications were observed. [Conclusion]Partial vertebrectomy with three columns reconstruction of spine through posterior approach for the treatment of severe single-segment lumbar burst fracture and dislocation has the advantages such as thorough spinal canal decompression, immediate postoperative stability of three-column spine and less operation injury. It is a safe and reliable operation method for the treatment of severe lumbar burst fracture and dislocation.