前路再手术治疗胸腰椎骨折

Re-operation of thoracolumbar vertebra fracture through anterior approach

目的 探讨对胸腰椎骨折后路手术后遗神经症状者行前路手术的适应证选择及手术要点。方法 选择 2 1例胸1 2 ～腰3 骨折脱位病例 ,均为后路减压固定术后遗不全截瘫者 ,对其行前路减压固定或单纯减压。疗效评定以手术前后排尿、感觉、运动功能、背痛以及影像学的改变等为指标。结果 2 1例有关症状均获不同程度的好转 ,均于术后第 1天起感觉功能障碍获不同程度改善 ,9例术后 3个月感觉功能障碍消失 ,肌力改善 1～ 2级。 1例术后 3周、1 1例术后 3个月排尿功能恢复。 2 1例背痛症状均缓解 ,影像学结果满意。结论 前路手术对不完全截瘫 (包括已行后路手术者 )能明显改善排尿等神经功能 ,提高生活质量。由于前路手术创伤大、出血多、操作较难、对完全性截瘫者疗效不确定 。

Objective To evaluate the indication and the operative skill of re operation on thoracolumbar vertebra fracture treated with surgery through anterior approach.?Methods Twenty one cases of T 12 -L 3 fracture had been treated with surgery through posterior approach and remained incomplete paraplegia. Re operation was performed through anterior approach procedure for decompression and fixation. Effective assessment of the re operation was proceeded by the comparison of the emiction,sensation,movement,the circumstance of back pain and image before and after operation.?Results Satisfactory results were obtained in 21 cases on various degrees of amelioration of sensation which occurred right in the first day after operation,9 cases got complete recovery of sensation and musclular power was strengthened for 1 2 grade. Improvement of emiction was approving:emiction function recovered in 1 case 3 weeks after operation,11 cases recorvered 3 months after operation. The pain in the back was remitted and a good result of image was found in 21 cases.?ConclusionSurgery through anterior approach may benefit incomplete paraplegia cases. As for its more hurt and bleeding,difficulty in operation and uncertain effect for the case of complete paraplegia,we definitely suggest the importance to master the indication of surgery through anterior approach.