严重下腰椎骨折脱位的后路手术治疗

The posterior surgery for serious lower lumbar fractures and dislocations

目的 评价后路经椎弓根三维矫正和减压手术对严重下腰椎骨折脱位的治疗效果。方法 回顾性分析经后路手术治疗的 2 3例严重下腰椎骨折脱位。主要损伤节段 ,L3 13例 ,L410例 ,其中有 2例为L4,5脱位。按AO进行骨折分类 ,A类 (压缩 ) 16例 ,B类 (分离 ) 1例 ,C类 (扭转 ) 6例。所有病例均行后路短节段经椎弓根复位内固定。分别比较术前与术后即刻的影像学指标变化 ,及术前与术后 2个月时神经功能的变化。结果 平均随访时间 13个月 (5～32个月 )。术后即刻影像学显示 ,伤椎椎体前高由术前平均 6 5 .3%恢复至 93.2 % (P <0 .0 1) ,伤段局部矢状径指数由术前平均 2 6 .8°恢复至 13.6°(P <0 .0 1) ,椎管受堵指数由术前平均 2 .96恢复至 1.2 2 (P <0 .0 1)。有神经损伤者其中半数 (18例中的 9例 )在术后 2个月时出现一定程度恢复。结论 对于严重的下腰椎骨折脱位 ,从后路进行减压和固定完全可以达到充分的治疗效果。

Objective To evaluate the results of transpedicular 3D correction and posterior decompression for serious lower lumbar fractures and dislocations. Methods 23 cases of serious lower lumbar fractures and dislocations treated posteriorly were analyzed retrospectively. The main injured segments were L_3 in 13 cases and L_4 in 10 cases including L_ 4,5 in 2 dislocations. Fracture types according to AO classification were type A (compression) in 16 cases, type B (distraction) in 1 case and type C (retortion) in 6 cases. All the 23 cases were treated with short-segmental transpedicular reduction and fixation. The imaging index of pre operation and postoperation as well as neurologic status of preoperation and 2 months of postoperation were compared respectively. Results All the cases had been followed up for an average of 13 months (5～32 months). The instant postoperative imaging index showed obvious improvement on the injured body height (from 65.3% preoperatively to 93.2% , P <0.01), the sagittal index (from 26.8°preoperatively to 13.6°, P <0.01) and the canal encroachment index (from 2.96 preoperatively to 1.22, P <0.01). Half of those with neurologic deficit (9 in 18 cases) had obtained some recovery within 2 months after operation. Conclusion Posterior decompression and fixation are successful in treating serious lower lumbar fractures and dislocations.