经单侧椎弓根内侧壁切除椎管前方减压后路复位固定术治疗胸腰椎爆裂骨折

The treatment of thoracolumbar vertebral bursting fractures by the method of anterior decompression and posterior reposition fixation applied in the affected vertebra via unipedicular pedicle medial wall by cutting vertebral canal

[目的]探讨经单侧椎弓根内侧壁切除椎管前方减压后路复位固定术治疗胸腰椎爆裂骨折的临床疗效。[方法]2010年10月～2011年11月胸腰椎爆裂骨折患者共40例。随机选取19例行经单侧椎弓根椎管前方减压后路复位固定术(A组),21例行经伤椎椎弓根置钉后路复位固定手术(B组)。神经功能按Frankel分级进行评估。记录手术时间和术中出血量。测量术前、术后3d及末次随访时的DR片及CT片比较伤椎前缘高度比、相邻椎Cobb角及椎管正中矢状径变化评估脊柱重建及骨折减压情况。[结果]A组在椎管矢状径的恢复方面明显优于B组,而A组手术时间、术中出血、伤椎前缘高度及相邻椎Coob角纠正、矫正度再丢失与B组无显著差异。两组患者神经功能都有程度不同的恢复,有效率无显著差异,而恢复1级以上的例数差异有显著性。所有病例术后无切口感染、脑脊液漏及深静脉血栓形成等并发症,术后复查DR片内固定未见松动、断裂。[结论]经单侧椎弓根内侧壁切除椎管前方减压后路复位固定术不仅能重建脊柱的生理曲度及稳定性,克服传统手术术后内固定失败、矫正度再丢失等不足,还能达到直接解除神经压迫,促进神经功能恢复,且没有增加手术时间与出血量,是一种治疗胸腰椎爆裂骨折安全有效的方法。

[ Objective ]To explore the clinical effect of the treatment of thoracolumbar vertebral bursting fractures by the method of anterior decompression and posterior reposition fixation applied in the affected vertebra via unipedicular pedicle medial wall by cut- ting vertebral canal. [ Method] Tbere were 40 cases of thoracolumbar vertebral bursting fractures in all from October 2010 to Novenfi3er 2011. Nineteen random samples of thoracolumbar vertebral burst fractures were treated by the method of anterior decompression and posterior reposition fixation applied in the affected vertebra via unipedicular pedicle medial wall by cutting vertebral canal （Team A）. The rest 21 cases were treated by the method of posterior reduction and fixation via injured vertebral pedicle screw （Team B）. Neuro- logical function was evaluated with the criteria of Frankel and recorded operation time and bleeding during operation. The vertebral anterior height ratio, adjacent vertebral Cobb angle and the median sagittal diameter of spinal canal were measured before the operation, 3 days after operation and last follow-up through DR and CT. Then the situation of spinal reconstruction and fracture decompression were assessed. [ Result ] Team A excels Team B in the restoration in sagittal diameter of spinal canal. Team A was almost the same as Team B in operation time, bleeding, vertebral anterior height, adjacent vertebral Cobb angle correction and loss of correction. Patients in both teams gained different degrees of recovery in neurologic function. There was no significant difference in efficiency while exists big difference for cases who recover to level one. There was no complication like postoperative incision infection, leakage of cerebrospinal or deep venous thrombosis among all cases. Patients were examined with DR after operation, unseen looseness and fracture. [Conclusion]The treatment of thoracolumbar vertebral burst fractures by the method of anterior decompression and posterior reposition fixation applied in the affected vertebra via unipedicular pedicle medial wall by cutting vertebral canal not only can rebuild the stability of spine, relieve neurothlipsis, accelerate the recovery of neurological function, but also overcome a lot of deficiencies caused by traditional operation. It is one of the safest and most effective ways to treat thoracolumbar vertebral burst fractures.