经后路前中柱稳定性重建术治疗严重胸腰椎骨折脱位

Stability reconstruction of anterior and middle column through posterior approach for severe thoracolumbar fracture-dislocations

目的 探讨经后路前中柱稳定性重建术治疗严重胸腰椎骨折脱位的临床疗效.方法 回顾性研究2010年1月至2013年12月我科收治的严重胸腰椎骨折脱位患者20例,其中男性18例,女性2例,年龄21-49岁,平均26.5岁.载荷分布评分（LSS）均≥7分.所有患者均接受经后路前中柱稳定性重建术治疗：后路经椎弓根伤椎次全切除、环脊髓减压、椎弓根螺钉内固定加钛网椎间植骨融合.记录评估手术前后伤椎高度丢失比例、后凸Cobb角、椎管占位比例、神经功能恢复及椎间植骨融合情况.根据Frankel脊髓损伤分级评价神经功能.结果 20例患者均获得6-36个月随访,平均30个月.术后伤椎高度丢失比例、后凸Cobb角、椎管占位比例较术前有明显改善（P＜0.05）.9例Frankel脊髓损伤分级由术前的A级恢复到术后C级,2例恢复到D级,其余9例无恢复.钛网植骨均获得良好骨性融合.结论 经后路胸腰椎前中柱稳定性重建术通过单一后方入路能同时完成严重胸腰椎骨折脱位的复位、减压、前中柱稳定性重建,较好地恢复脊柱正常生理曲度,实现早期活动及功能操练,是一种治疗严重胸腰椎骨折脱位的理想技术.

Objective To evaluate the clinical efficacy of stability reconstruction of anterior and middle colunm throughposterior approach in treatment of severe thoraeolumbar fracture-dislocations. Methods From January 2010 to December 2013, atotal of 20 patients diagnosed as severe thoracolumbar fracture-dislocation were enrolled in this study, including 18 males and 2females, with an average of 26. 5 years （from 21 to 49 years）. Load-sharing scores （LSS） were 97 points. All patients wereoperated by stability reconstruction of anterior and middle column through posterior approach. The loss of traumatic segmentalheight, segmental kyphosis, decompression of the spinal canal, neurolngic status and bone grafting were evaluated. Neurologicdeficits were assessed according to Frankel grading systerr Results All cases were successfully followed up for an average of 30months （range, 6-36 months）. Compared with the preoperative results, the postoperative loss of traumatic segmental height,segmental kyphosis, decompression of the spinal canal were improved significantly （P〉0.05）. Nine cases with Frankel score Alevel improved to C level, 2 cases with Frankel score A level improved to D level, while the rest showed no improvement.Constructed stability was found in all patients. Conclusions Stability reconstruction of anterior and middle column throughposterior approach could complete restoration, decompression and reconstruction from the only one incision, and early drillingactivities and functions to achieve, it is an ideal surgical technique for severe thoracolumbar fracture-dislocation.