270°融合治疗胸腰段三柱骨折效果观察

The Curative Effect of 270 Degrees Fusion Treatment of Thoracolumbar Fracture with Three Column

目的:对经椎间孔椎体间植骨+对侧关节突间植骨270°融合治疗胸腰段三柱骨折患者的临床效果进行观察。方法:2011年1月-2015年12月应用270°融合治疗新鲜累及三柱的胸腰椎爆裂骨折87例,在采用后路减压固定基础上均行伤椎经椎间孔椎体间植骨+对侧关节突间植骨融合术。记录手术时间及出血量,从影像学检查、腰痛情况、神经功能恢复三个方面评价治疗效果。采用正侧位X光片了解脊柱生理曲度、骨折情况及内固定物位置,采用二维CT了解植骨融合情况。并于术后1周、3、12个月测量记录Cobb角。神经功能恢复情况按ODI评分标准评定及ASIA分级。结果:本组87例患者手术时间135~172 min,平均143 min。术中出血量460~780 ml,平均565 ml。所有均获得随访,随访12~50个月,平均35个月。术后骨折复位良好,椎体及椎间隙高度恢复满意,侧后凸矫正良好。手术前Cobb角为(26.52±4.23)°,术后3个月Cobb角为(3.87±1.93)°,术后12个月Cobb角为(3.95±2.02)°;手术前后相比差异有统计学意义(t=26.95,P=0.00),手术后3个月与12个月对比差异无统计学意义(t=1.79,P=0.07)。根据ODI评分标准评定,术前平均78分,术后平均28分,平均改善率为64.2%;术后ASIA分级大部分不同程度改善。术后12个月二维CT复查,植骨均获得骨性融合,无内固定断裂和松动并发症。结论:对于三柱损伤的脊柱胸腰段骨折患者,在钉棒系统复位、短节段或长节段固定及减压的基础上,经过椎间孔椎体间植骨+对侧关节突间植骨重建椎体高度,能够较好地矫正脊柱畸形,恢复神经功能,有利于术后椎体高度和角度的维持,患者中远期治疗效果满意,值得进一步在临床推广。

Objective ： To observe the clinical efficacy of the transforaminal interbody bone graft plus contralateral facet 270 degree fusion in the treatment of thoracolmnhar fracture with the three column.Method： From January 2011 to December 2015, using a 270 degree fusion treatment of thoracolumbar fresh in three columns of 87 cases of burst fractures in the posterior decompression and fixation were performed on the basis of vertebral transforaminal lumbar interbody fusion of bone grafting plus side joint.The operation time and hlood loss were recorded, anti the therapeutic effects were evaluated from three aspects, imaging examination, low back pain and nerve function recovery.The lateral X ray to understand the physiological curvature of the spine, fracture and internal fixation, bone graft fusion with 2D CT.The Cobb angle was measured at 1 week, 3 and 12 months.Neurological function was assessed according to ODI score and grade ASIA. Result： The operation time of 87 patients in this group was 135-172 minutes, with an average of 143 minutes.The intraoperative blood loss was 460-780 ml, with an average of 565 ml.All patients were followed up for 12 to 50 months（an average of 35 months）.Good fracture reduction and vertebral height recovered satisfactorily after operation, good correction of kyphosis.Preoperative Cobb angle （26.52 ~ 4.23）degrees, the Cobb angle was （3.87 _＋ 1.93）~ at 3 months after operation, and the Cobb angle was （3.95 -＋ 2.02）~ after operation for 12 months, statistically significant difference between before and after surgery（t=26.95, P=0.00）.There was no significant difference between 3 months and 12 months after operation（t=l.79, P=0.07）.According to the ODI score, the average score was 78 before operation, and the average was 28 after operation.The average improvement rate was about 64.2%.The postoperative ASIA scores were improved in varying degrees.At 12 months after operation, the bone graft fusion was obtained by two-dimensional CT, and the~ was no complication of internal fixation.Conclusion： For patients with fracture of thoracolumbar spine injury in the three column, the screw rod system reset, short or long segment fixation and decompression on the basis of the transforaminal interbody bone grafting plus contralateral joint reconstruction of vertebral height, capable of correcting the spinal deformity, restore nerve function, maintain the vertebral height and the angle for postoperative patient outcomes, hmg-term satisfaction.This deserves further clinical promotion.