后路与前后联合入路治疗胸腰段椎体爆裂骨折对比研究

Posterior vs combined anteroposterior approach for subtotal resection of vertebral body, implantation of titanium cage and pedicle screw reconstruction in treatment of thoracolumbar burst fracture

目的对比分析单纯后路与前后联合入路椎体次全切、钛网及椎弓根钉重建术治疗重度胸腰段椎体爆裂骨折的疗效。方法回顾性分析自2007年1月～2009年12月行手术治疗的47例累及三柱的胸腰段椎体爆裂骨折，单纯后路椎体次全切、钛网及椎弓根钉重建术组（A组）19例，前后联合入路椎体次全切、钛网及椎弓根钉重建术组（B组）28例。结果本组获随访6～28个月，平均18．5个月。手术时间及出血量A组少于B组，且差异有统计学意义（P〈0．05）。两组术后椎体前缘高度、损伤节段后凸角（Cobb角）及椎管容积均显著恢复。除5例全瘫患者外，两组ASIA神经功能评分较术前均有1级或l级以上改善。A组19例术中硬脊膜破裂2例，术后腹胀、便秘3例，腰神经功能损伤1例；B组28例术中大出血1例，术后血气胸6例，肺部感染2例，腹胀、便秘10例，切口肋间神经痛4例。结论与前后联合入路相比，单纯后路椎体次全切、钛网及椎弓根钉重建术操作相对简单，创伤小，出血少。手术并发症少，临床效果满意。

Objective To compare the clinical results between posterior vs combined anteroposterior approach for subtotal resection of vertebral body, implantation of titanium cage and pedicle screw reconstruction in treatment of serious thoracolumbar burst fracture. Methods From January 2007 to December 2009, a total of 47 patients with serious thoracolumbar burst fracture undergoing surgical intervention were retrospectively analyzed, including 19 cases （group A） with posterior approach for subtotal resection of vertebral body, implantation of titanium cage and pedicle screw reconstruction and 28 （group B） with combined anteroposterior approach. Results The mean foUow-up time was 18.5 months （range, 6～28）. The group A was superior to the group B in operation time and amount of bleeding （P 〈0.05）. There were satisfactory restdts in anterior height of fractured vertebral, the kyphosis （Cobb＇s angle） and occupation of the canalis vertebralis after operation. All patients had neurofunctional recovery at least one grade, except five patients who were graded to the A. In 19 cases of group A, 2 patients＂ dura mater were torn, 3 patients appeared ventosity and constipation, lumbar nerve-root injure occurred in 1. In 28 cases of group B, 1 patient appeared intra-operative massive baemorrhage, 6 patients appeared hemopneumothorax, 2 patients appeared pulmonary infection, 10 patients appeared ventosity and constipation, 4 patients appeared intercostal neuralgia. Conclusion Compared with combined anteroposterior approach, the posterior approach for subtotal resection of vertebral body, implantation of titanium cage and pedicle screw reconstruction has the superiority of simplicity of operation, less injury, less bleeding, less complication. It is worth popularizing due to its satisfactory clinical Results.