椎管次全环状减压术治疗陈旧性胸腰段骨折伴顽固性神经病理性疼痛

Semicircular decompression for the treatment of old thoracolumbar fractures and intractable neuropathic pain

目的：探讨椎管次全环状减压术治疗陈旧性胸腰段骨折伴顽固性神经病理性疼痛患者的临床疗效。方法：2009年9月至2013年9月，采用椎管次全环状减压术治疗陈旧性胸腰段爆裂骨折伴顽固性神经病理性疼痛21例。所有患者初次手术均为后路椎弓根钉系统内固定伴或不伴相应节段椎板切除术。患者均为男性，年龄20±28岁，平均（25．00±2．38）岁；椎体残留骨块椎管内占位〉50％；均为完全性脊髓损伤（ASIA级）或马尾神经损伤；VAS评分6～10分，平均（7．14±0．91）分。手术前后对患者进行MRI、CT、X线检查，记录止痛药使用种类及用量，并对患者手术前后的神经功能（ASIA分级）及疼痛状况（VAS评分）进行评估。结果：所有病例获得随访，时间8—32个月，平均（17．29±6．02）个月。21例患者均经后路手术去除椎管内占位骨决，解除其对脊髓、神经根压迫；12例患者感觉平面下移，但ASIA分级没有变化；术后VAS评分0-8分，平均（2．43±2．46）分，与术前比较差异有统计学意义（P〈0．05）。其中11例停用镇痛剂，7例镇痛剂减量，3例无改善。结论：陈旧性胸腰椎骨折术后伴严重神经病理性疼痛患者，应尽早行MRI、CT、X线等影像学检查，如果椎管内存在明显占位骨块，椎管次全环状减压术可有效缓解疼痛症状并有利于神经功能的进一步恢复。

Objective：To investigate the clinical outcomes of semicircular decompression in treating old thoracolumbar fractures and intractable neuropathic pain. Methods： From September 2009 to September 2013,21 patients with old thoracolumbar fracture and intractable neuropathic pain were treated with semicircular decompression. Among initial surgery, posterior pedicle screw fixation was used in these patients ,with or without laminectomy. All patients were male ,range in age from 20 to 28 years old with an average of （25.00±2.38） years. Vertebral body residual bone block resulted in intra-spinal placeholder more than 50%. All patients were complete spinal cord injury （ASIA grade） or cauda equina injury. VAS scores was from 6 to 10 points with the mean of 7.14±0.91. In these patients, M RI, CT, X-rays were performed;denomination and dosage of analgesics were recorded; nerve function and pain status were respectively evaluated by ASIA grade and VAS score before and after operation. Results：All patients were followed up from 8 to 32 months with an average of （17.29±6.02） months. All bone fragments of spinal canal were removed and spinal cord decompressions were achieved. At final follow-up, VAS scores were from 0 to 8 points with an average of （2.43±2.46） points, and were obviously reduced than peroperative data （P〈0.05）. Eleven cases of them stopped analgesic intake and 7 cases reduced using. Three patients＇ symptoms and VAS scores were not improved. Conclusion： Old thoracolumbar fractures and intractable neuropathic pain need receive imaging examination as soon as possible and consider semicircular decompression therapy if bone fragments were in vertebral canal and spinal canal stenosis existed. This therapy can effectively relieve pain and profit nerve functional recovery.