Moss Miami系统和椎体前路撑开器联合应用治疗胸腰椎体骨折

Thoracolumbar fractures treated with Moss Miami system and anterior distract ion device

目的探讨MossMiami系统和椎体前路撑开器(anteriordistractiondevice,ADD)联合使用治疗胸腰椎体骨折的经验。方法对德国UnfallkrankenhauseBerlin创伤与重建外科收治的28例胸腰椎骨折病人采用后路MossMiami系统固定,行前路减压后植入自体骨,以ADD撑开固定。结果28例术中、术后无死亡及神经损伤,1例术中出现硬脊膜撕裂。所有患者平均随访11.8个月。MossMiami系统和ADD的位置与术后照片无明显改变24例;3例ADD较明显嵌入椎体矫正角丢失<5度;1例ADD侧方倾斜移位。5例不全瘫痪病人,术后神经功能完全恢复3例,部分改善2例。结论MossMiami系统和ADD联合使用治疗胸腰椎骨折,具有椎管减压彻底,内固定可靠,病人可早期下地,术后矫正角丢失少等优点,是不稳定性胸腰椎骨折较理想的治疗方法。

Objective To review our experience in treatin g thoracolumbar fractures with Moss Miami System and vertebra an-terior distractio n device(ADD). Methods Twenty-eight patients with thoracolumbar fractures admitt ed in the Department of Trauma and Reconstructive Surgery (Unfallkrankenhause, Berlin, Germany) were treated by posterior fixation with Moss Mia-mi system and anterior decompression, followed by autologous bone grafting and ADD stabilizing implant. Result Death oc-curred in none of the cases and no patients exhibited signs of neurologic damages both intraoperatively and postoperatively, with the only exception that disruption of the dura mater of the spinal cord occurred in 1 case intraoperatively. Follow-up study lasting for a mean period of 11.8 mon ths was conducted in all the cases, which found that the position of Moss Miami system and implanted ADD remained unchanged in 24 cases, in comparison with the ir position as shown by postoperative imaging data. In 3 cases, however, ADD wa s inlaid in the vertebral body, with an angle correction loss of which was less than 5 degrees. Lateral obliquity and displacement of ADD was found in 1 case. Of the 5 incomplete paraplegic pationts, 3 achieved complete habilitation of n eurologic function and 2 had partial improvement. Conclusion Moss Miami system a nd ADD constitute good modalities in treating thoracolumbar fractures, with suc h merits as thorough decompression of the spinal canal, reliable fixa-tion to al low early force loading with less correction loss of the angle, and are therefor e suitable for treating unstable thora-columbal fractures.