后外侧减压前后一体固定技术治疗胸腰椎骨折

Posterolateral decompression combined with anterior- posterior fixation for treatment of thoracolumbar vertebral fracture

[目的]探讨后外侧减压结合钉棒系统前后一体固定技术治疗胸腰椎爆裂性骨折的可行性及临床效果。[方法]回顾性分析解放军第101医院2009年12月~2013年12月采用后外侧减压结合钉棒系统前后一体固定技术治疗单节段胸腰椎爆裂性骨折患者,本研究共36例患者,男24例,女12例,年龄26~62岁,平均38.4岁。损伤节段：T_（11）10例,T_（12）14例,L_18例,L_24例,致伤原因：车祸伤20例,坠落伤13例,压砸伤3例。神经功能按Frankel分级：A级2例,B级5例,C级8例,D级8例,E级13例。通过对术前、术后及末次随诊时影像学指标神经功能的变化分析临床疗效。[结果]36例均获随诊,随诊时间12~36个月,平均16个月。术后1年随诊时按Frankel评分标准,均有1~3级不同程度恢复,腰背痛视觉模拟评分（VAS）较术前明显改善。患者均获得骨性愈合,随诊影像学检查示椎管狭窄率、Cobb角、椎体前后高度、神经功能恢复较术前明显改善,无内固定松动或断裂等并发症发生。[结论]后外侧减压结合钉棒系统前后一体固定技术创伤小,减压彻底,能良好的恢复脊柱的三柱稳定性,降低内固定失败发生率,是治疗胸腰椎爆裂骨折的有效方法。

[ Objective ] To investigate the feasibility and clinical outcome of posterolateral decompression combined with anterior - posterior nail - stick system fixation in the treatment of thoracolumbar burst fracture. [ Method ] Thirty - six patients underwent posterolateral decompression combined with anterior - posterior nail - stick system fixation for single - segment thora- columbar burst fracture in the 101 ~t Hospital of PLA from December 2009 to Decend3er 2013. Among these patients, there were 24 male patients and 12 female patients, aged 26 -62 years （mean age 38.4 years）. According to the injured segment, 10 pa- tients had T11 injury,14 had T12 injury,8 had L~ injury,and 4 had L2 injury. The reasons for injury were car accidents in 20 pa- tients, falling in 13, and smashing and pressuring in 3. The Frankel grading system showed 2 patients was grade A ,5 grade B,8 grade C ,8 grade D, and 13 grade E deficit. The radiological neurological function parameters before surgery, after surgery,and at the end of follow - up were compared to analyze clinical effect. [ Result] All the 36 patients were followed up for 12 - 36 months （mean 16 months）. According to the Frankel grade at 1 year after surgery, the patients experienced varying degrees of recovery （ grades 1 - 3 ）, and the visual analogue scale score for low back pain was significantly improved after surgery. All the patients a- chieved bony union, and radiological examination during follow - up showed significant improvements in spinal canal stenosis rate, Cobb angle, anterior -posterior vertebral height, and the recovery of neurological function. There were no complications of internal fixation loosening or rupture. [ Conclusion ] Posterolateral decompression combined with anterior - posterior nail - stick system fixation causes less trauma, reduces the pressure thoroughly, helps to restore the stability of the spinal cord, and reduces the incidence of internal fixation failure. Therefore,it is an effective method for the treatment of thoracolumbar vertebral burst fracture.