前路减压固定钛网植骨重建治疗胸腰椎爆裂骨折疗效分析

Anterior Decompression and Reconstruction with Titanium Mesh and Bone Graft for Thoracolumbar Blowout Fractures Combined Spinal Cord Injury

目的探讨前路减压内固定钛网植骨重建治疗胸腰椎爆裂骨折的疗效。方法采用胸腰椎前路手术治疗胸腰椎爆裂性骨折67例,其中T11 5例,T12 27例,L1 25例,L2 4例,L3 2例,L4 4例。Frankel分级:A级14例,B级9例,C级19例,D级13例,E级12例。术前Cobb角平均30.0°±7.2°。结果本组67例均顺利完成前路手术,平均手术时间4.8(3.5～6.0)h;术中出血平均800(380～3 000)ml,术中大出血4例,46例输血,平均输血600(400～2 400)U。所有患者切口均Ⅰ期愈合。术后Cobb角平均3.0°±1.5°,椎体高度基本恢复。本组67例均获得随访,平均20(10～24)个月,Cobb角和椎体高度无明显丢失,内固定物未见明显松动及断裂,无钛网移位,椎体间全部融合,无假关节形成。术后Frankel分级:A级2例,B级13例,C级4例,D级18例,E级30例。术后并发症:腹胀25例,神经根症状5例,胸膜破裂与气胸2例,脑脊液漏1例,经对症处理后均恢复。结论运用前路减压、钛网重建治疗胸腰椎骨折可直视下充分减压,矫正畸形,脊髓神经功能可获得良好恢复。

Objective To evaluate the clinical effect of anterior decompression and reconstruction with titanium mesh and bone graft for thoracolumbar blowout fractures combined spinal cord injury. Methods 67 cases with thoracolumbar blowout fractures combined spinal cord injury were treated by anterior approach decompression and reconstruction with titanium mesh fixation and bone graft. The involved vertebral body was Tll in 5 cases, T12 in 27 cases, L1 in 25 eases, L2 in 4 cases, 1.3 in 2 cases and IA in 4 cases. According to Frankel classification, there was grade A in 14, grade B in 9, grade C in 19, grade D in 13 and grade E in 12. The Cobb angle was 27°±48°with an average of 30.0°± 7.2°. Results All 67 cases accomplished the surgery, the mean operative duration was 4. 8 hours and the mean intraoperative blood loss was 800 ml. All incision healed in stage I. The Cobba angle was corrected to 3.0°± 1.5°, and the height of vertebral body was restored. All cases were followed up from 10 to 24 months （ mean 20 months）. The correction loss of Cobb angle and vertebral body height was not found. The internal fixators were not loose and breaking, the titanium mesh was not shift. All cases gained vertebral fusion without pseudoarticulation formation. Postoperative Frankel classification was grade A in 2, grade B in 13, grade C in 4, grade D in 18 and grade E in 30. The postoperative complications was abdominal distention in 25 cases, radicular symptoms in 5 cases, pleura rupture and pneumothorax in 2 cases and cerebrospinal leak in 1 case, and all of them were recovered by symptomatic treatment. Conclusion Anterior decompression and reconstruction with titanium mesh and bone graft can achieve sufficient decompression to spinal cord under direct vision, effective deformity correction and good restoration of postoperative neurological function for thoracolumbar burst fractures combined spinal cord injury.