经横突窗椎间孔入路治疗胸腰椎爆裂性骨折

Treatment of Thoracolumbar Burst Fractures through Transforaminal Approach in the Window of Transverse Process

目的探讨经横突窗椎间孔入路治疗骨折块突入椎管的胸腰椎爆裂性骨折的可行性及临床疗效。方法回顾性分析自2007年9月至2011年3月收治的85例侵入骨块占椎管矢状径比率大于30%胸腰椎爆裂性骨折患者,按胸腰椎损伤严重度评分（the thoracolumbar injury severity score,TLISS）载荷总评分为4～7分,平均为5.4分;按Frankel分级,A级9例,B级12例,C级19例,D级14例,E级31例。所有病例均采用经横突窗椎间孔入路减压、后外侧植骨融合内固定术式。结果手术均顺利完成,手术时间90～130 min,平均为110 min;术中出血量为150～340mL,平均220 mL;术后椎体高度恢复满意,成角畸形消失;术后Franke1分级,A级6例,B级9例,C级16例,D级13例,E级41例,Franke1分级平均提高1～3级;术前术后椎体楔变角、交界性后凸角改变差异有统计学意义（P〈0.05）。结论经横突窗椎间孔入路治疗胸腰椎爆裂性骨折具有入路简单、能同时兼备前路和后路术式的优点,椎管减压彻底,可有效恢复椎管容积和脊柱稳定性,是治疗胸腰椎爆裂骨折的理想新术式。

Objective To investigate the feasibility and efficacy of of thoracolumbar burst fractures with fracture fragments in spinal canal through transforaminal approach in the window of transverse process.Methods A retrospective analysis was carried out for 85 cases of thoracolumbar burst fracture from September 2007 to March 2011,and there were fracture fragments which were more thanl 30% diameter of spinal canal ratio.According to the TLISS,the total score was 4 to 7,averaged 5.4,and by Frankel grade,9 cases with type A,12 cases with type B,19 cases with type C,14 cases with type D,31 cases with type F.All patients were treated by decompression,posterolateral bone graft fusion,and internal fixation through transforaminal approach in the window of transverse process.Results Operation were successfully completed,the operative time was from 90 to130 min with an average of 110 min,and the amount of blood loss was from 150 to 340 mL with an average of 220 mL; postoperative vertebral height recovered satisfactorily,angular deformity disappeared; postoperative Franke classification was improved by an average of 1 to 3,and there were A grade in 6 cases,B grade in 9 cases,C grade in16 cases,D grade in 13 cases,E grade in4 1 cases; preoperative and postoperative vertebral wedge angle,junctional kyphosis change had significant difference（ P〈0.05）.Conclusion The operation through transforaminal approach in the window of transverse process implemented easily,and it also has the advantages of both anterior and posterior operation in treatment of thoracolumbar burst fracture.It is an ideal new option that can fully decompress,effectively restore the volume of vertebral canal and spinal stability.