经椎弓根椎体部分切除减压内固定治疗胸腰段爆裂骨折

Clinical Analysis of Treatment of Thoracolumbar Burst Fracture with the Posterior Vertebral Sub-total Decompression and Fixation

目的探讨对伴脊髓损伤(spinal cord injury,SCI)的胸腰段骨折行后路经椎弓根椎体部分切除减压椎间植骨融合结合椎弓根系统内固定术的临床疗效。方法选取120例Denis B型胸腰椎爆裂性骨折患者,随机分2组,每组60例:A组为后路治疗组,B组为前路治疗组。手术前后及随访阶段均以骨折椎体为中心摄正、侧位X线片。了解术后及随访期间骨折复位丢失情况,有无内固定折断,椎弓根钉松动、拔出,椎弓根钉或内固定圆棒折断等。按美国脊髓损伤协会标准评价神经功能。比较术后1周、术后12个月椎体成角、上下终板成角有无差异,神经功能恢复情况。比较各组患者治疗前后椎体成角、上下终板成角的差异及手术时间、出血量的差异、神经功能恢复情况的差异。结果前路治疗组与后路治疗组患者治疗前后椎体成角、上下终板成角及神经功能恢复情况无明显差异(P>0.05),但手术时间、出血量有明显差异(P<0.05),B组相对于A组手术时间短、出血量少。术后随访期间无内固定松动、断裂等并发症发生,植骨融合良好,无植骨不融合、骨吸收、椎体塌陷等情况。结论后路经椎弓根椎体部分切除减压单间隙融合双节段固定是治疗Denis B型胸腰椎爆裂性骨折的有效方法。

Objective To evaluate the clinical value of treatment of thoracolumbar burst fracture with the posterior verte- bralsub-total decompression and fixation. Methods 120 patients were randomly divided into two groups（60 cases for each）. Group A were treatred with posterior decompression, Group B were treated with anterior decompression. Therapeutic outcome was assessed on 1 th week and 12th month after operation, which included the vertebral angle, the superior-inferior endplate angle. Neurological improvement were assessed according to ASIA grading scale. All cases were followed up. Results There were statistically significant differences（P 〈0.05） in the above two parameters between preoperation and postoperation in vertebral angle, the superior-inferior endplate angle in every group, but there were no statistically significant differences（ P 〉 0.05 ） between group A and group B on the vertebral angle, the superior-inferior endplate angle, neurological improvement. Blood loss of Group B was significantly lower than group A （ P 〈 0.05 ）. Operation time of group A was longer than group B （ P 〈 0.05 ）. All eases got bone union. The position of internal fixation was good during follow-up. Results showed a satisfactory outcome. Most of the patients obtained therapeutic effect after treatment. No severe complications were found throughout this study. The complica- tions such as disruption, breaking or loosening of the screwsor rods and collapse were not observed. Conclusion The application of single segmental spinal interbody fusion with bisegment fixation through posterior approach is a satisfactory technique for the treatment of thoracolumbar burst fracture of Dennis type B with SCI.