椎管开窗减压结合椎弓根固定治疗椎管侵占胸腰椎爆裂骨折

Laminar fenestration combined with pedicle screw stabilization for management of thoracolumbar burst fracture with canal encroachment

目的探讨后路椎板开窗减压结合椎弓根固定治疗有椎管侵占的胸腰椎爆裂骨折的可行性。方法选择2005年1月—2008年12月胸腰椎骨折AO分型A3型骨折患者52例，椎管侵占通过伤椎椎板开窗，将骨折块推移复位，椎弓根固定，不需要椎问植骨融合。对所有患者椎管侵占、椎体前缘高度丢失、伤椎椎体Cobb角度改变及神经功能损害行术前、术后对比。结果术后随访24个月。椎管侵占从术前的（68.3±15.1）％恢复至术后的（11.5±3.9）％（P〈0.05）；伤椎后凸Cobb角由术前的（32.5±3.2）。恢复至术后的（4.9±0.6）。（P〈0.05）；椎体高度丢失由术前的（50.1±5.6）％恢复至术后的（85.5±5.1）％（P〈0.05）。末次随访时，椎体骨折愈合，椎体高度无明显丢失，患者神经功能均有恢复。结论椎板开窗减压结合椎弓根固定技术治疗A3型骨折可以获得良好的影像学和临床结果，是治疗A3型骨折的一个可靠选择。

Objective To detect the possibility of posterior laminar fenestration combined with screw instrumentation for treatment of thoracolumbar burst fracture with canal encroachment. Methods Between January 2005 and December 2008, 52 patients with AO-A3 thoracolumbar fracture underwent laminar fenestration to achieve canal decompression and pediele screw instrumentation without interhody fusion. Canal encroachment, loss of anterior vertebral height, Cobb＇ s angle, and neurologic outcome were measured before and after operation. Results All patients were followed up for 24 months. Canal encroachment improved from preoperative （68.3±15.1 ）% to postoperative （ 11.5±3.9 ）% （P〈0.05 ）. Cobb＇ s angle reduced from preoperative （ 32.5±3.2）°to postoperative （4.9±0.6）°（ P〈 0.05 ）. Loss of anterior vertebral height restored from preoperative （ 50.1± 5.6 ） % to postoperative （ 85.5±5.1 ） % （ P 〈0.05 ）. At the final follow-up, neurological recovery and fracture healing with no apparent vertebral height loss were noted for all patients. Conclusion Flaminar fenestration combined with pediele screw stabilization attains good radiographic and clinical resuhs in treating patients with AO-A3 thoracolumbar burst fracture.