后路伤椎上间隙融合双节段固定治疗Denis B型椎体爆裂性骨折的临床研究

Clinical research of posterior injured intervertebral fusion combined with double-segmental fixation in the treatment of thoracolumbar burst fractures of Denis type B

目的探讨后路伤椎上间隙融合双节段固定治疗Denis B型椎体爆裂性骨折的临床疗效。方法选取本院2008年2月～2011年3月收治的Denis B型椎体爆裂性骨折患者14例,均采用后路伤椎上间隙融合双节段固定治疗,比较患者治疗前后的各项临床指标。结果患者平均术中出血量为(469.8±92.7)mL,平均手术时间为(131.6±14.2)min,术后24 h的伤口平均引流量为(280.1±34.3)mL,平均骨折愈合时间为(16.1±2.9)周。术后发生感染1例,脊柱曲度发生异常改变1例,并发症发生率为14.3%。患者术后Frankel分级评定情况明显好于术前,患者术后伤椎前缘高度、伤椎后缘高度、椎管容积率均明显大于术前,患者术后Cobb角明显小于术前,差异均有统计学意义(均P<0.05)。结论后路伤椎上间隙融合双节段固定治疗Denis B型椎体爆裂性骨折具有显著的临床疗效,不仅保留了患者伤椎下位的椎间盘,还恢复了患者的脊柱生理曲度并重建了患者的脊柱稳定性,是一种安全有效的手术方法,值得临床推广使用。

Objective To investigate the efficacy of posterior injured intervertebral fusion combined with double-segmental fixation in the treatment of thoracolumbar burst fractures of Denis type B.Methods 14 cases with thoracolumbar burst fractures of Denis type B in our hospital during February 2008 to March 2011 were treated with posterior injured intervertebral fusion combined with double-segmental fixation.Clinical indexes were compared respectively between berore and after the therapy.Results Mean intraoperative bleeding volum was（469.8±92.7） mL,mean operating time was（131.6±14.2） min,the wound average lead flow in postoperative 24 h was（280.1±34.3） mL,mean healing time was（16.1±2.9） weeks.1 case of patient with postoperative infection and 1 case of patient with spinal curvature changed abnormally were found.The complication rate was 14.3%.Patients′ postoperative Frankel grading was obviously better than the preoperative evaluation.Postoperative anterior margin height and posterior margin height of the injured vertebral body,vertebral canal volume rate of patients were significantly greater than those of preoperation.Postoperative Cobb angle was significantly smaller than that before operation,all of the differences were statistically significant（all P 0.05）.Conclusion The efficacy of posterior injured intervertebral fusion combined with double-segmental fixation in the treatment of thoracolumbar burst fractures of Denis type B is significant.This operation can not only retain the intervertebral disc under injured vertebra,but also restore the spinal physiological curvature and reestablish spinal stability.It is a safe and effective operation method,it is worthy of widely clinical use.