经伤椎固定联合椎板开窗治疗伴有椎管侵占的胸腰椎骨折

Vertebral fixation combined with fenestration in the treatment of thoracolumbar vertebral fractures with spinal canal invasion

目的观察经伤椎椎弓根螺钉固定联合椎板开窗减压治疗伴有椎管侵占的胸腰椎骨折手术效果。方法选择伴有椎管侵占的单节段胸腰椎骨折患者30例,均采用经伤椎椎弓根螺钉短节段固定,单侧或双侧椎板开窗脊髓减压治疗;分别测量术前、术后及末次随访时的椎体相对高度、后凸角(Cobb角),观察椎管占位改善情况,以美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级评估手术后神经功能恢复情况。结果所有手术均顺利完成,术中因骨块损伤硬膜导致脑脊液漏5例,经严密缝合筋膜组织并行腰大池置管引流后均Ⅰ期愈合。平均随访17.2个月,未发现内固定物松动、移位、折断及骨折椎体塌陷等情况。术后1周到末次随访,伤椎平均高度有了明显提高,局部Cobb角明显变小,术后1周时椎管侵占率已明显下降,以上指标与术前比较差异均有统计学意义(P<0.01)。术前ASIA分级为A级0例、B级10例、C级11例、D级5例、E级4例,末次随访时ASIA分级为A级0例、B级1例、C级3例、D级7例、E级19例,术前与末次随访时比较差异有统计学意义(Uc=4.593,P=0.003)。结论经伤椎固定联合椎板开窗脊髓减压是治疗伴有椎管侵占的胸腰椎骨折最直接有效的方法,可促进受损神经的恢复,减小手术创伤,有效恢复并维持伤椎的高度。

Objective To investigate the clinical effect of vertebral pedicle screw fixation combined with fenestration in the treatment of thoracolumbar vertebral fractures with spinal canal invasion.Methods Thirty cases of thoracolumbar vertebral fractures with spinal canal invasion patients accepted the procedure of vertebral fixation combined with fenestration treatment.The recovery of vertebral body height,improvement of Cobb angle and neurological function improvement were recorded and analyzed.Results All operations were successful.Five cases of cerebrospinal fluid leakage encountered,and they healed well after suitable treatment.The average postoperative follow up were 17.2months.There was no internal fixation loosening,displacement,fracture and vertebral collapse happened.One week after surgery,the average height of the injured vertebra was significantly increased.Local Cobb angle was decreased obviously.At 1week after operation,the spinal canal invasion rate was decreased significantly.There were statistically significant differences for the above indexes compared to the preoperation（P〈0.01）.Based on the ASIA score system,there was grade A with 0cases,grade B with 10 cases,grade C with 11 cases,grade D with 5cases,grade E with 4cases before the operation.There was grade A with 0cases,grade B with 1cases,grade C with 3cases,grade D with 7 cases,grade E with 19 cases before the operation for last follow-up.There were statistically significant differences for the above indexes compared to the pre-operation（Uc=4.593,P=0.003）.Conclusion As an effective method to treat thoracolumbar vertebral fractures with spinal canal invasion,vertebral pedicle screw fixation combined with fenestration had the characteristic of improve the neurological recovery,sustain vertebral height and avoid the spinal deformity occurred.