一期后路椎体次全切除,钛网重建联合经伤椎椎弓根钉内固定治疗严重多节段胸腰椎骨折临床观察

Clinical effects of subtotal corpectomy and three column stabilization combined with pedicle screw including the fracture vertebra on severe multilevel thoracic and lumbar fractures

目的:探讨一期后路椎体次全切除,钛网重建联合经伤椎椎弓根钉内固定治疗严重的多节段胸腰椎骨折的疗效。方法:回顾性分析11例行一期后路椎体次全切除,钛网重建联合经伤椎椎弓根钉内固定治疗严重多节段胸腰椎骨折患者的临床资料。比较术前及术后患者的椎管内容积、椎体高度、后凸角及椎体复位情况,神经功能恢复情况,评估临床疗效。结果:所有患者均获得随访,脱位椎体均完全复位,患者非严重节段骨折术前椎体前缘高度与后缘比值平均为(40.7±5.1)%,术后为(72.7±4.7)%,后凸角术前为(29.2±6.3)°,术后为(9.2±3.1)°;严重骨折节段术前后凸角度后凸(15.6±1.4)°,术后为前凸(19.7±2.7)°,椎管内骨块占位面积术前(81.2±3.2)%,术后为0,差异均有统计学意义(P<0.01)。7例患者的神经功能有不同程度恢复。结论:一期后路椎体次全切除,钛网重建联合经伤椎椎弓根钉内固定治疗有利于恢复多节段骨折椎体高度、胸腰椎的生理曲度和神经功能,具有良好的临床疗效。

Objective：To evaluate clinical effects of subtotal corpectomy and three column stabilization combined with pedicle screw including the fracture vertebra through posterior approach on severe multilevel thoracic and lumbar fractures . Methods：Eleven cases of severe multilevel thoracic and lumbar fractures were treated by subtotal corpectomy and three column stabilization combined with pedicle screw including the fracture vertebra through posterior approach. The reduction, height of the fractured vertebra, the neurological recovery, the Cobb’s angle and spinal canal compromise were evaluated before and after operation. Results：All the cases were followed up, 5 cases achieved recovery of neurological function in different degrees, and there was no internal fixation failure in all cases , for the height of the fracture vertebra which was not severe was （40.7±5.1）% before operation （72.7±4.7）%,and the Cobb’s angle was （29.2±6.3）°before operation （9.2±3.1）°. For the severe vertebra Cobb’s angle is （15.6±1.4）°kyphosis before operation,（19.7±2.7）°lordosis after the operation; spinal canal compromise was （81.2±3.2）% before the operation and zero after the operation. Conclusion： This therapeutic method may be an effective treatment for severe multilevel thoracic and lumbar fractures.