胸腰椎爆裂性骨折前路手术的影像学评价

Radiologic Evaluation of Anterior Approach in the Treatment of Thoracolumbar Burst Fracture

目的：从影像学方面评估前路手术在胸腰椎爆裂性骨折治疗中的价值。方法：对54例胸腰椎爆裂性骨折病例行一期前路减压、植骨融合、内固定术，测量术前、术后及随访时的Cobb’s角、伤椎椎体压缩率及椎管狭窄率，并进行统计学分析。结果：5例失访，49例进行3个月～9年的随访。X线片检查提示植骨均融合，内固定位置良好。在矢状位Cobb’s角术前为（26．7±5．2）°，术后为（3．6±4．5）°，随访时为（3．8±4．9）°，术后脊柱曲度接近正常生理曲度。伤椎前缘高度压缩率由术前的49．18％±12．32％，降低到术后的13．10％±8．96％；伤椎后缘高度压缩率由术前的11．32％±4．94％，降低到术后的4．64％±3．87％；椎管狭窄率术前为55．46％±14．35％，术后为2．89％±2．15％；放射学检查各指标手术前后比较差异均有统计学意义（P〈0.01），且随访时未发现矫正角度和高度的丢失，植骨融合率为100％．结论：前路手术是治疗胸腰椎爆裂性骨折有效的方法，它具有良好的恢复椎体高度、矫正后凸畸形、扩大椎管容积的能力。

Objective.. To evaluate clinical efficacy of the anterior approach in the treatment of thoracolumbar burst fracture by radiologic image. Methods：All 54 cases of thoracolumbar burst fracture underwent a one-stage direct anterlateral decompression, antologous bone-grafting reconstruction, and fixation procedure. The cobb＇s angle in sagittal kyphosis, rate of compression of injured vertebra, and spinal canal narrowing were measured and statistically analyzed before and after operation, and at the final followed-up. Results.. Five cases were lost to follow-up, and 49 cases were followed up for 3 months to 9 years. X-rays showed successful bone fusion and good position of internal fixation. The Cobb＇s angle in sagittal plane was 26.7±5.2 degree preoperative, 3.6±4.5 degree postoperative, and 3.8±4.9 degree at the final follow-up. The spinal curvature was approximation to normal lordosis. The vertebral compression rate of anterior height was down from 49.18± 12.32% preoperative to 13.10±8.96 % postoperative, and the vertebral compression rate of posterior height was decreased from 11.32±4.94% preoperative to 4.64±3.87% postoperative. The spinal stenosis rate was 55.46 ± 14.35% preoperative and 2.89±2.15 % postoperative. The parameters of radiology were significantly different before and after surgery. There was not loss of correction angle and height in followed up, and the ratio of bone fusion was 100%. Conclusion： The anterior approach was an effective method in the treatment of thoracolumbar burst fracture, which is suitable to recover vertebral height, to correct kyphosis, and to enlarge the volume of vertebral canal.