胸腰椎爆裂骨折前路术后疗效的远期观察

Long Term Effect of Anterior Approach Operation for Thoracolumbar Burst Fracture

目的观察胸腰椎爆裂骨折前路术后远期疗效。方法选取西南医科大学附属医院脊柱外科2005年5月至2010年5月采用胸腰椎前路技术治疗胸腰椎爆裂骨折167例,所有患者术前、术后1、3、5年随访时行X线片、三维CT观察椎间支撑体有无下沉、移位,测量伤椎及临椎椎间高度,coob角;MRIT2像采用Pfirrmann分级系统评估融合节段相邻椎间盘退变情况;VAS评分评价术后临床效果。结果所有患者均顺利完成手术,86例患者平均随访5年以上,术后5年随访复查胸腰椎CT、X片与术后1年椎间高度,Coob角比较无明显变化。3例支撑体轻度倾斜或下沉。Pfirrmann分级系统评估临近节段椎间盘MRIT2像术后5年2例Ⅰ级椎间盘退变为Ⅱ级;5例Ⅱ级椎间盘退变为Ⅲ级;2例Ⅲ级椎间盘退变为Ⅳ级;1例Ⅳ级椎间盘退变为Ⅴ级。VAS评分较术前比较差异有统计学意义(P<0.05)。结论胸腰椎爆裂骨折前路术后远期内固定物无松动和断裂。椎间支撑体无明显下沉,倾斜。相邻节段退变率低,并发症少,临床疗效满意。

Objective To observe the long term effect of anterior approach operation for thoracolumbar burst fracture.Methods 167 cases of thoracolumbar burst fracture received in Department of Spine Surgery,the First Affiliated Hospital of Southwest Medical University,during May 2005 to May 2010,were treated by thoracolumbar anterior approach operation. Before operation and during 1,3,5 years post-operation follow-up,X-ray photography and 3 D-CT were used to observe whether the intervertebral support subsided or displaced and to measure the intervertebral height as well as Coob angle between the injured vertebrae and adjacent vertebrae. In MRI（T2 WI）,Pfirrmann grading standard was adopted to evaluate the degeneration of intervertebral disc adjacent to fused segments. Post-operation clinical effect was determined by VAS scoring. Results Surgery of all patients were completed successfully and 86 cases of patients were followed up for more than 5 years. The intervertebral height and Coob angle measured in reexamined thoracolumbar X-ray photography and CT in 5 year post-operation follow-up showed no significant change to 1 year post-operation follow-up. There were 3 cases whose support slightly inclined or subsided. As intervertebral disc of adjacent segments in MRI（T2 WI） was evaluated by Pfirrmann grading standard,5 years after operation,2 cases of Grade Ⅰ intervertebral disc degenerated to Grade Ⅱ,5 cases of Grade Ⅱ intervertebral disc degenerated to Grade Ⅲ,2 cases of Grade Ⅲ intervertebral disc degenerated to Grade Ⅳ and 1 case of Grade Ⅳ intervertebral disc degenerated to Grade Ⅴ. Compared with pre-operation VAS scores,Post-operation VAS scores had statistically significant difference with pre-operation VAS scores（P〈 0. 05）. Conclusion In long term,after anterior approach operation for thoracolumbar burst fracture,there is no looseness or breakage of the internal fixation and no obvious subsidence or incline of the intervertebral support. The degeneration rate of adjacent segments is low,with less complications and satisfying clinical effect.