后路椎体次全切钛网植入内固定治疗胸腰椎爆裂骨折

Posterior subtotal vertebraectomy,titanium cage reconstruction and internal fixation in the treatment of thoracolumbar burst fractures

目的探讨经后路椎体次全切钛网植骨融合椎弓根钉内固定治疗胸腰椎爆裂骨折的临床疗效。方法 2012年6月～2014年6月,笔者运用胸腰椎损伤评分系统（TLICS评分）和脊柱载荷评分系统（LSC评分）,对纳入的35例成人[男性21例,女性14例;年龄26～45岁,平均（37.4±6.3）岁]胸腰椎爆裂骨折,采用一期经后路椎弓根内固定撑开复位,伤椎椎体次全切,椎管减压,钛网植骨融合手术。采用美国脊柱损伤学会分级（ASIA）进行神经功能评估,通过X线和CT评估术前、术后及末次随访时伤椎椎体高度、椎管占位情况和椎间融合情况。结果手术均顺利完成,6例术后并发脑脊液漏,余无严重并发症发生。所有病例均获随访,随访时间平均为（15.3±6.8）个月,除5例患者术前神经功能为A级外,余30例患者神经功能均有不同程度提高。术后影像学显示减压及复位效果满意,末次随访时植骨全部获得骨性融合,无假关节形成。结论经后路椎体次全切减压,前中柱重建脊柱序列,固定融合治疗胸腰椎爆裂骨折手术操作相对简便,减压彻底,并发症少,有效恢复椎体高度及椎管容积,是胸腰椎骨折的一种有效治疗方法。

Objective To evaluate the efficacy and prognosis of treating thoracolumbar burst fractures by subtotal vertebreectomy, titanium cage reconstruction and fixation with pedicle screw through posterior approach. Methods From Jun.2012 to Jun.2014,35 patients[21 males and 14 females aged from 26-45 years with an aver-age age of （37.4 ±6.3）years] with thoracolumbar burst fractures who were sleceted by thoracolumbar injury classi-fication and severity score system and loading sharing classification system,were treated by posterior subtotal resec-tion of vertebral body with implantation of titaium cage and distraction reduction fixation at one stage.Neurological status before and after operation and during the final follow-up was reviewed by American Spinal Injury Association （ASIA） scoring system.The distraction,occupation and fusion status were radiologically reviewed.Results All operations were carried out successfully.Cerebrosinal fluid leakage occurred in 6 patients and the others had no postoperative complications.All patients were followed up with an average of （15.3 ±6.8） months.Nervous func-tion improved in different degrees in 30 patients and 5 patients had the nervous function of grade A.Radiological re-sults showed satisfactory decompression and reduction after operation.All patients had complete bony fusion at the final follow-up without pseudathrosis.Conclusion It is an ideal operation method for the treatment of thoracolum-bar burst fractures by subtotal resection of vertebral body,reconstruction of the anterior and middle columns with tita-nium cage and fixation with pedicle screw through posterior approach.It has the advantages of convenient operation, less complications,thorough decompression and sufficient recovery of vertebral body height and canal volume.