胸腰椎爆裂性骨折的手术治疗

Operative treatment of burst fracture of thoracolumbar vertebrae

目的 探讨胸腰椎爆裂性骨折的最佳治疗方案 ,提出最佳手术时机、手术指标和手术方法。方法 对 6 8例胸腰椎爆裂性骨折的患者进行手术治疗 ,行后路减压 5 6例 ,经后入路椎弓根侧前方减压 12例 ,采用“锤入法”或“潜挖法”切除从前方压迫脊髓或马尾神经的椎体碎块 ,采用Dick’s椎弓根钉内固定 15例 ,双哈氏棒固定 42例 ,哈 鲁氏棒固定 8例 ,鲁氏棒固定 3例 ,并行椎间关节突植骨 15例。结果 随访 4个月至 4年 4个月 ,平均 2年。术后内固定稳固 ,骨折复位佳 ,椎管有效径恢复 ,术后神经功能较术前有较大恢复。结论 胸腰椎爆裂性骨折 ,骨折块占据椎管容积 1/ 3以上 ,椎管矢径小于10mm应积极进行手术椎管减压 ,后路复位固定 ,纠正后弓角 ,注意术中复位达到以下三项标准 :a .压缩椎体张开 80 %以上 ;b .后弓角 <10° ;c .

HT5”H]Objective [HT5”SS]To explore the best method for the treatment of burst fracture of thoracolumbar vertebrae,and to study the best opportunity,index and method of operation.[HT5”H]Methods [HT5”SS]68 cases of burst fracture of thoracolumbar vertebrae were treated with operation.Posterior decompression was performed in 56 cases and lateral anterior decompression of pediculus arcus vertebrae was done with posterior approach in 12 cases.Vertebrae fragments compressing spinal cord or cauda equina from the anterior were hammered into the cancellous vertebral body or excised.Of the 68 cases,15 were fixed with Dick’s nails,42 with double Harrington’s rods,8 with Harrington Luque’s rods,3 with Luque’s rods,and 15 had undergone bone grafting in between the interspinous articular process.[HT5”H]Results [HT5”SS]The follow up period ranged from 4 months to 4 years and 4 months,with an average of 2 years.The results showed stable and firm internal fixation,satisfactory fracture reduction,effective recovery of diameter of vertebral canal as well as much better postoperative nerve function.[HT5”H]Conclusion [HT5”SS]Vertebral canal decompression operation,posterior reduction and fixation should be applied for the burst fracture of thoracolumbar vertebrae if the size of fracture piece was more than 1/3 of volume of vertebral canal and the sagittal diameter of vertebral canal was less than 10mm.During the operation,the follow three standards of reduction should be attained:a.compressed vertebral body stretched more than 80%;b.posterior arch angle was less than 10°;c.interspinous dislocation was reducted completely.