后路椎管270°环形减压伤椎置钉内固定治疗胸腰椎爆裂性骨折

Effect of posterior spinal decompression through 270° ring decompression and pedicle screw fixation on thoracolumbar burst fracture

背景:经后路椎管环形减压治疗胸腰椎爆裂性骨折是在较少破坏脊柱的原有稳定性基础上,通过较小的创伤即可使伤椎椎管狭窄获得直接彻底的减压,包括全环形、次环形及半环形减压。目的:探讨后路椎管270°环形减压伤椎置钉内固定治疗胸腰椎爆裂性骨折的方法及临床效果。方法:2015年1月至2017年1月行后路椎管270°环形减压伤椎置钉内固定治疗32例胸腰椎爆裂性骨折患者,男17例,女15例;年龄29~58岁,平均(48.8±6.6)岁。结果:32例全部获得随访,随访时间为6~12个月,平均(8.7±2.3)个月。患者脊柱生理曲度维持良好,无后凸畸形和继发性椎管狭窄发生。脊柱Cobb角:术前22.5°±1.2°,术后3.8°±1.0(P<0.05)°;伤椎压缩程度:术前49.1%±11.7%,术后11.3%±3.6%,差异均有统计学意义(P<0.05)。神经功能按照Frankel分级:术前为A级5例,B级9例,C级10例,D级7例,E级1例;术后神经功能好转为B级2例,C级8例,D级11例,E级11例。结论:经后路椎管270°环形减压伤椎置钉内固定可重建脊柱稳定性,同时有效防止继发性椎管狭窄,治疗胸腰椎爆裂性骨折的效果良好。

Background： Posterior spinal canal decompression is used in the treatment of thoracolumbar burst fracture,which can make the vertebral canal stenosis decompressed directly and thoroughly through minor trauma, including full ring, sub ring and semi ring decompression, but maintain the original stability of the spine. Objective： To explore the feasibility and clinical effect of posterior decompression of the vertebral canal with 270o and internal fixation on thoracolumbar burst fracture. Methods： A total of 32 patients with thoracolumbar burst fracture were treated with posterior decompression of vertebral canal by 270o and internal fixation of the injured vertebra from January 2015 to January 2017 including 17 males and 15 females. The range of age was 29-58 years with the average age（48.8 ± 6.6） years. Results： All the patients were followed up for 6-12 months with the average（8.7±2.3）. The patients maintained a good physiological curvature of the spine without kyphosis and secondary spinal stenosis. The spinal Cobb angle was improved from preoperative 22.5°±1.2° to postoperative 3.8°± 1.0°（P〈0.05）. The vertebral compression degree was 49.1%±11.7% preoperative and 11.3%±3.6% postoperative, and the difference was statistically significant（P〈0.05）. According to Frankel classification, there were 5 patients of grade A, 9 patients of grade B, 10 patients of grade C, 7 patients of grade D and 1 patients of grade E before the operation. Neurological function was improved after surgery with 2 patients of grade B, 8 patients of grade C, 11 patients of grade D and 11 patients of grade E. Conclusions： The posterior decompression of the vertebral canal with 270o and vertebral pedicle screw fixation is an effective method for thoracolumbar burst fractures, which can not only reconstruct spinal stability but also effectively prevent secondary spinal stenosis.