后路减压重建前中柱治疗胸腰段爆裂性骨折

Posterior decompression and reconstruction of anterior and middle columns for the treatment of thoracolumbar burst fractures

目的探讨后路减压重建前中柱治疗胸腰段爆裂性骨折的临床效果。方法 2013-05-2016-12的46例胸腰段爆裂性骨折患者的TLICS评分平均6.3分(5-8分),LCS评分平均7.7分(7-9分),合并脊髓神经功能障碍40例。所有患者实施一期后路减压复位以及前中柱重建(TLIF或PLIF技术)。术前、术后1周、术后3个月及末次随访时的X线片测量患者后凸Cobb角、椎间高度,评估椎间融合情况。术前、术后神经功能评定采用Frankel分级。结果术后患者神经功能除了6例A级的无恢复外,其他患者均较术前有改善。患者术前、术后1周、术后3个月以及末次随访时的后凸Cobb角分别为20.2°、2.1°、2.4°和2.5°;椎间高度分别为32.9、57.8、56.4、55.1 mm;患者术后1周的后凸Cobb角及椎间高度均较术前有明显改善(P<0.05);术后3个月、末次随访时的后凸Cobb角及椎间高度之间差异无统计学意义。结论后路减压重建前中柱治疗胸腰椎爆裂性骨折可以有效矫正后凸和维持椎体间的高度,重建脊柱的稳定性,是一种安全有效的手术方式。

Objective To investigate the clinical effect of posterior decompression and reconstruction of anterior and middle columns in the treatment of thoracolumbar burst fractures Methods From May 2013 to December 2016,46 cases with thoracolumbar burst fracture were selected. The average TLICS score was 6.3 points （5-8 points）,and the average LCS score was 7.7 points （7-9 points）,46 cases were complicated with spinal nerve dysfunction. All patients underwent one-stage posterior decompression and anterior column reconstruction （TLIF or PLIF）. X-ray films were used to measure the kyphosis Cobb angle and intervertebral height before operation,1 week after operation,3 months after operation and the last follow-up. Preoperative and postoperative neurological function evaluation was performed by Frankel classification. Results In addition to the no recovery of 6 cases of class A, the other patients had different degrees of improvement. The height of the intervertebral body was 32.9, 57.8, 56.4, 55.1 mm, respectively, before operation, 1 week, 3 months after operation and at the last follow-up,and the Cobb angle was 20.2, 2.1, 2.4 and 2.5, respectively. The intervertebral height, kyphosis Cobb angle were significantly improved at 1 week after operation （!〈0.05）,and there was no significant difference between the intervertebral height,the kyphosis Cobb angle at 3 months and the last follow-up. Conclusion Posterior decompression and reconstruction in the treatment of thoracolumbar burst fracture can effectively correct the height of the kyphosis and maintain the vertebral body, and reconstruct the stability of the spine. It is a safe and effective operation.