经后路保留胸椎后柱结构椎体次全切术治疗胸椎爆裂骨折及胸椎Kümmell病伴脊髓损伤的疗效观察

Effect of subtotal vertebral body resection with preservation of thoracic posterior column structure through posterior approach in treatment of thoracic burst fracture and thoracic Kümmell disease with spinal cord injury

目的探讨经后路保留胸椎后柱结构椎体次全切术治疗胸椎爆裂骨折及胸椎Kümmell病伴脊髓损伤的临床疗效。方法回顾性分析自2013-08—2017-08采用经后路保留胸椎后柱结构椎体次全切术治疗的19例胸椎爆裂骨折及胸椎Kümmell病伴脊髓损伤,比较术前与术后6个月胸椎管前后径比值、横断面积比值、JOA评分以及ASIA脊髓损伤等级。结果 19例均顺利完成手术并获得完整随访,随访时间1~4年,平均2.2年。术后出现脑脊液漏1例,切口愈合不良1例,对症治疗后均治愈。术后6个月胸椎管前后径比值、横断面积比值、JOA评分较术前提高,差异有统计学意义(P<0.05)。术后6个月ASIA脊髓损伤等级:D级1例,E级18例。结论经后路保留胸椎后柱结构椎体次全切术治疗胸椎爆裂骨折及胸椎Kümmell病伴脊髓损伤在保留了脊椎后柱结构完整性同时,可以对胸椎管前方能充分减压,去除脊髓前方的压迫,获得满意临床疗效。

Objective To explore the clinical effect of subtotal vertebral body resection with preservation of thoracic posterior column structure through posterior approach for thoracic burst fractures and thoracic Kümmell disease with spinal cord injury.MethodsNineteen cases of thoracic burst fractures and thoracic Kümmell disease with spinal cord injury treated with subtotal vertebral body resection with preservation of thoracic posterior column structure through posterior approach from August 2013 to August 2017 were retrospectively analyzed. The ratio of anteroposterior diameter and cross-sectional area of thoracic spinal canal, JOA score before and 6 months after operation were compared.ResultsAll the 19 cases successfully completed the operation and received complete follow-up. The follow-up time was 1 to 4 years, with an average of 2.2 years. One case had cerebrospinal fluid leakage after operation, and one case had poor incision healing. All were cured after treatment. The ratio of anteroposterior diameter, cross-sectional area ratio, and JOA score of thoracic spinal canal at 6 months after operation were higher than before operation, the difference was statistically significant(P<0.05). ASIA spinal cord injury grade at 6 months after operation was 1 case of grade D and 18 cases of grade E.ConclusionSubtotal vertebral body resection with preservation of thoracic posterior column structure through posterior approach for thoracic burst fractures and thoracic spine Kümmell disease with spinal cord injury can preserve the structural integrity of the posterior spine, and in the same time fully decompress the front of the thoracic spinal canal and remove the compression in the front of the spinal cord, achieving satisfactory clinical effects.