胸腰椎骨折手术适应证及其远期疗效观察

Surgical indication and long-term following-up results of thoracolumbar vertebral fractures

目的 探讨胸腰椎骨折的手术适应证及后路椎管环形减压、椎体内植骨的远期疗效。 方法 1994～ 2 0 0 0年 ,采用椎管环形减压 ,结合横突间、椎板间和经椎弓根椎体内植骨技术 ,治疗 176例胸腰椎骨折。术前及不同随访时间行CT检查 ,分别计算其伤椎椎管狭窄率 ,确定椎管矢状径的恢复程度 ,采用配对t检验方法进行统计学分析。 结果 97例患者术后平均随访 2 3.2个月 ,按美国脊髓损伤学会 (ASIA)神经损伤分级标准评定 ,71例脊髓不完全性损伤患者中 ,6 4例分别提高 1～ 3级 ,7例无变化 ;2 6例完全性脊髓损伤患者部分神经根功能有所恢复。CT检查显示 ,术前伤椎椎管狭窄率平均 44 .7% ,术后伤椎椎管减压充分 ,1年后出现椎管再塑形现象 ,再塑形的伤椎椎管管径与正常理论值比较 ,差异无显著性意义 (P >0 .0 5 )。 结论 大部分脊髓不完全性损伤的椎体骨折应采用手术治疗。对无神经压迫症状的不稳定性爆裂型骨折 ,手术治疗是预防晚期并发症的有效方法。椎管环形减压后 1年 ,椎管表现出自发再塑形现象 ,塑形后的椎管管径在正常理论值范围。

Objective To explore the surgical indication of and the effect of spinal canal circum decompression, bone graft and internal fixation on thoracolumbar vertebral fractures. Methods A total of 176 patients, suffering from thoracolumbar vertebral fractures, were treated with the operation of hypo circum or half circum decompression, combined with intertransverse, intervertebral and transpedicular internal pyramid bone grafts.The severity of spinal canal stenosis of the injured vertebrae was calculated and the recovery degree of the sagittal diameter of the vertebral canal was determined respectively according to the CT films obtained before operation and in various time intervals of following up. The data were analyzed by paired Student's t test. Results A total of 97 patients were followed up for 23.2 months averagely. For the patients with incomplete spinal cord injury, the ASIA was improved for 1 3 grades in 64 patients and didn't change in 7 patients. For the rest 26 patients with complete spinal cord injury, the function of spinal nerve root recovered partially. The severity of spinal canal stenosis of the injured vertebrae was 44.7% averagely before operation, and the spinal canal diameter recovered completely after operation. The spinal canal remolding occurred after 1 year. And there existed no significant difference between the remolded spinal canal diameter and the normal spinal canal diameter. Conclusions Surgical treatment should be carried out for the majority of the patients with incomplete spinal cord injury, also for the patients with unstable burst fracture even without neurological deficit in order to prevent later complications. The spinal canal remolding appears generally in 1 year after circum decompression. And the remolded spinal canal diameter is similar to the normal ones. Transpedicular bone grafting in vertebra body benefits to prevent the vertebra body from collapse after operation.