经后路360°减压结合伤椎植骨治疗胸腰椎爆裂骨折并不全瘫痪的疗效分析

An analysis on the curative effect of posterior approach 3600 decompress and vertebral fixation in treating thoracolumbar vertebrae burst fracture and incomplete paralysis

目的探讨经后路360°减压结合伤椎植骨治疗胸腰椎爆裂骨折并不全瘫痪的手术方法与临床疗效。方法回顾性分析自2012年1月至2014年10月采用后路360°减压结合伤椎植骨治疗胸腰椎爆裂骨折并不全瘫27例,所有患者均为单椎体爆裂骨折。比较术前及术后3 d、3个月、1年的椎体前缘高度比、Cobb角,术前及末次随访时脊髓神经功能Frankel分级。结果 27例均获得随访12~18个月,平均14个月。末次随访时脊髓神经损伤Frankel分级:A级0例,B级1例,C级2例,D级4例,E级20例。术后3 d、3个月、1年伤椎椎体前缘高度比分别为(91.7±3.5)%、(90.6±3.9)%、(90.1±3.5)%,较术前明显恢复,差异有统计学意义(F=173.513,P<0.001)。术后3 d、3个月、一年的Cobb角分别为(5.7±1.1)°、(6.0±1.5)°、(6.0±1.2)°,Cobb角矫正后明显改善,差异有统计学意义(F=31.210,P<0.001)。结论经后路3600减压结合伤椎植骨治疗胸腰椎爆裂骨折并不全瘫痪疗效满意,是较为理想的治疗方法。

Objective To explore the surgical method and clinical efficacy of treating thoracolumbar vertebrae burst fracture and incomplete paralysis with posterior approach 3600 decompress and Vertebral fixation.Methods The data of 27 cases of thoracolumbar vertebrae burst fracture complicated by incomplete paralysis treated with posterior approach 3600 decompress and vertebral fixation was retrospectively analyzed. The ratio of anterior vertebral height and Cobb angle before and 3 days,3 months,and 1 year after operation,the Frankel grading of spinal nerve function before operation and at the last follow-up were recorded and compared.Results The average follow-up period of these 27 cases was 14 months（ range from 12 to 18 months）. The Frankel grading of spinal cord injury at the last follow-up were： Grade A（ 0）,grade B（ 1）,grade C（ 2）,grade D（ 4）,grade E（ 20）. The postoperative anterior vertebral height on 3 rd day,3 rd months,and 1 year after surgery were：（ 91.7±3.5） %,（ 90.6±3.9） %,and（ 90.1±3.5） %,which showed an obvious recovery compared with that before operation. The difference was statistically significant（ F = 173.513,P〈0.001）. The Cobb angle on 3 rd day,3 rd month,and 1 year after surgery were：（ 5.7±1.1） °,（ 6.0±1.5） °,（ 6.0±1.2） °,which also obviously improved compared with that before operation. The difference was statistically significant（ F = 31. 210,P〈0. 001）.Conclusions Posterior approach＂360°＂decompress and vertebral fixation is an ideal way to treat thoracolumbar vertebrae burst fracture and incomplete paralysis.