后路短节段固定结合潜行减压治疗上腰椎爆裂性骨折

Posterior short segment fixation with undermining decompress for upper lumbar burst fractures

目的 ：观察后路短节段固定结合保留后方韧带复合体（PLC）的潜行减压治疗上腰椎爆裂性骨折的临床效果。方法：2010年10月至2013年3月采用后路短节段复位固定和保留PLC的潜行减压治疗上腰椎爆裂性骨折患者（Denis B型）23例,男18例,女5例;年龄26~64岁,平均45.7岁;高处坠落伤12例,车祸伤5例,重物砸伤4例,其他外伤2例;L1骨折14例,L2骨折9例;伴神经损害13例（ASIA评分D级）。术后12~20个月（平均14.3个月）取出内固定。术后定期随访并比较各时间点神经功能JOA评分和影像学动态变化。结果：所有患者获得随访,时间18~24个月,平均20.4个月。13例伴神经损害者术后3~6个月神经症状均完全恢复。术后1年和去除内固定后3个月JOA评分分别为20.63±0.92和20.38±1.06,较术后3个月的9.90±2.73明显改善（P〈0.05）。术后1年伤椎前缘高度、伤椎楔变角、局部Cobb角分别为（95.1±0.53）%、（2.78±1.36）°、（2.43±1.52）°,均较术前明显改善（P〈0.05）。去除内固定3个月后与术后1年JOA评分及影像学结果比较差异无统计学意义（P〉0.05）。结论：后路短节段复位固定结合保留PLC的潜行减压治疗上腰椎爆裂性骨折创伤小,能有效恢复椎体高度,维持脊柱稳定性,减轻术后腰背痛,是安全有效的手术方式。

Objective：To observe clinical effects of posterior short segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures. Methods：From October 2010 to March 2013,23 patients with upper lumbar burst fractures（Denis B type） were treated by posterior short segment fixation with undermining decompress by posterior ligament complex. There were 18 males and 5 females aged from 26 to 64 years old with an average of45.7 years old. Twelve patients were caused by falling down,5 cases were caused by traffic accident,4 cases were the bruise injury caused by heavy object and 2 cases were caused by other injury. Fourteen patients were L1 fracture and 9 patients were L2 fracture. Thirteen patients were combined with nerve injuries（degree D according to ASIA classification）. Internal fixation were removed from 12 to 20 months with an average of 14.3 months. JOA scores and imaging changes were recorded and compared at different time points. Results：All patients were followed up from 18 to 24 months with an average of 20.4 months.Thirteen patients with nerve injuries were completely recovered at 3 to 6 months after operation. JOA score at 1 year after operation was 20.63±0.92,and 20.38±1.06 at 3 months after removal of internal fixation,which were improved obviously than 9.90±2.73 at 3 months after operation.（P〉0.05） Anterior height of injured vertebrae,vertebral body angle and local Cobb angle was（95.0±0.53）%,（2.78±1.36）°and（2.43±1.52） °respectively,and improved obviously than that of before operation（P〈0.05）.There was no statistical significance in JOA scores at 3 months after removal of internal fixation and 1 year after operation（P〉0.05）. Conclusion：posterior short segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures has advantages of minimally invasive,could effective recover vertebrae height,maintain stability of spine,decrease low back pain. It is a safe and effective operative method.