后路经单侧椎弓根椎体次全切减压植骨融合内固定治疗严重胸腰段椎体骨折

Treatment of severe throracolumar fractures with posterior decompression, subtotal vertebrectomy, intervertebral fusion and internal fixation through unilateral pedicle

目的探讨采用后路经单侧椎弓根椎体次全切减压植骨融合内固定治疗严重胸腰段椎体骨折的临床疗效。方法对自2009年3月至2012年6月采用后路经单侧椎弓根椎体次全切、椎管减压、椎间植骨融合内固定治疗的11例严重胸腰段椎体骨折患者资料进行回顾性分析，男10例，女1例；年龄20-42岁，平均31．1岁；骨折AO分型：B1型2例，B2型3例，c2型6例，Gaines前柱稳定性评分〉6分；所有患者均有不同程度的神经功能障碍。术后随访骨折复位、植骨愈合和神经功能恢复情况。结果本组患者手术时间200～330min，平均243．2min；出血量800～1600mL，平均1023．3mL。无术后神经症状加重或出现新的神经症状，3例患者术后出现脑脊液漏，经拔管后加压包扎、床尾抬高自愈。所有患者术后随访12～30个月，平均18．3个月。1例患者术后6个月出现尾端一侧固定螺栓脱落，无不适，未做特殊处理。术后X线片示骨折复位满意，植骨位置良好，CT片示椎管内无骨块占位；植骨融合时间3～6个月，平均4．3个月。末次随访时伤椎椎体高度无丢失。术后脊髓完全性损伤患者脊髓功能无恢复，Frankel分级仍为A级；1例脊髓不完全损伤患者由Frankel分级B级恢复至D级；8例圆锥损伤患者7例恢复至E级，1例恢复至D级；1例单纯马尾神经损伤者，症状有所恢复。结论采用后路经单侧椎弓根椎体次全切、椎管减压、锥间植骨融合内固定治疗严重胸腰段椎体骨折可满意复位骨折，彻底解除椎管内压迫，很好的重建脊柱稳定性，是一种可选择的有效方法。

Objective To evaluate the effects of posterior decompression, subtotal vertebrectomy, intervertebral fusion and internal fixation through unilateral pedicle in the treatment of severe throraeolumar fractures. Methods A retrospective study was conducted to evaluate the outcomes of ll patients with severe throracolumar fracture who had been treated with posterior decompression, subtotal vertebrectomy, in- tervertebral fusion and internal fixation through unilateral pedicle at our department from March 2009 to March 2012. They were 10 males and one female, aged from 20 to 42 years （mean, 31. 1 years）. According to AO classification, there were 2 cases of type B1, 3 cases of type B2 and 6 cases of type C2. The Gaines scores for anterior column stability were more than 6 in all. All the patients had neurological disorders. The fracture reduction, fusion of bone grafting and recovery of neurological function were followed up. Results Their operation time ranged from 200 to 300 minutes, averaging 243.2 minutes; the amount of bleeding ranged from 800 to l, 600 mL, averaging 1,023.3 mL. No deterioration of neurological symptoms or no new neurological symptoms were observed postoperatively. Cerebrospinal fluid leakage was found in 3 patients who healed spontaneously following extubation, compressive dressing and elevation of the bed end. All the patients were followed up for 12 to 30 months （average, 18.3 months）. A loosened screw cap was found in one patient after 6 months who had no discomfort and received no treatment. X-ray films showed satisfactory fracture reduction and fine bone grafting locations. No spinal canal stenosis was found by CT scans. It took 3 to 6 months （mean, 4.3 months） for the bone grafts to get fused. No height loss of the injured vertebrae was no found at the last follow-ups. No functional recovery was found in the patients with complete spinal cord injury whose Frankle grade remained A. The spinal function recovered from Frankel grade B to grade D in one patient with in-complete spinal injury. Of the 8 patients with medullary cone injury, 7 recovered Frankle grade E and one Frankle grade D. The symptoms were relieved in one patient with simple cauda equine injury. Conclusion Posterior decompression, subtotal vertebrectomy, intervertebral fusion and internal fixation through unilateral pedicle is an effective alternative for treatment of severe throracolumar fractures, because it can lead to satis- factory fracture reduction, thorough decompression of the spinal canal and good reconstruction of spinal sta- bility.