经后路椎体次全切除、钛网植骨及椎弓根螺钉置入内固定修复胸、腰椎爆裂骨折或合并脱位

Subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach in treatment of thoracolumbar burst fracture or thoracolumbar fracture dislocation

背景:胸腰椎爆裂性骨折或合并脱位均是脊柱外科常见的骨折类型,对于这类损伤常采用手术治疗,不同修复方式均有各自的优缺点。目的:探讨经后路椎体次全切除、钛网植骨及椎弓根螺钉置入内固定修复胸、腰椎爆裂骨折或合并脱位的效果。方法:回顾性分析2010年10月至2013年10月收治的18例单节段胸、腰椎爆裂骨折或合并脱位患者的临床资料,均采用后路椎体次全切除、钛网植骨及椎弓根螺钉内固定治疗,比较手术前后神经功能Frankel分级变化,术前、术后即刻、末次随访时伤椎前缘高度、Cobb角及椎管容积变化情况,以评价临床修复效果。结果与结论:(1)所有患者均获随访,随访时间24-38个月,随访期间无内固定松动、断裂及钛网下沉等并发症发生;(2)术后即刻椎体前缘高度、椎管容积、脊柱后凸Cobb角均较术前显著改善,差异有显著性意义(P<0.05),而末次随访与术后即刻比较差异无显著性意义(P>0.05);(3)结果显示,经后路椎体次全切除、钛网植骨及椎弓根螺钉置入内固定修复胸、腰椎爆裂骨折或合并脱位,可有效恢复椎体高度、脊柱后凸Cobb角及椎管容积,是安全有效的修复方式。

BACKGROUND： Thoracolumbar burst fracture or thoracolumbar fracture dislocation are the common types of fracture in spine surgery. Surgical treatment is often used for this kind of injury. Different surgical methods have their own advantages and disadvantages.OBJECTIVE： To evaluate the clinical effects of subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach alone in treatment of thoracolumbar burst fracture or thoracolumbar fracture dislocation. METHODS： Data of 18 patients of thoracolumbar burst fracture or thoracolumbar fracture dislocation were retrospectively analyzed from October 2010 to October 2013. They were treated by subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach alone. The neurological status was compared by Frankel scoring system pre-operatively and post-operatively. The anterior height of the fractured vertebral, Cobb angle of the fractured vertebral by radiographs and the volume rate of spinal canal were calculated pre-operatively, post-operatively and final follow-up. Repair effects were evaluated. RESULTS AND CONCLUSION：（1） All patients were followed up for 24 to 38 months. All patients were cured and instrumentations were not loose and broken. Titanium mesh subsidence did not occur.（2） The anterior height of the fractured vertebral body, the volume rate of spinal canal and the average Cobb angle were significantly improved, and there was a significant difference of all indices between preoperatively and postoperatively（P〈0.05）, but no significant difference between final follow-up and immediately after surgery（P〈0.05）.（3） Results suggested that treatment of thoracolumbar burst fracture or thoracolumbar fracture dislocation by subtotal corpectomy and reconstruction with titanium mesh cage implantation and pedicle screw fixation through posterior approach alone are effective and safe in reconstructing intervertebral body height, Cobb angle and spinal canal volume.