改良胸腰椎前路固定技术治疗胸腰椎骨折的临床观察

Clinical observation of a modified anterior fixation technique for thoracolumbar fractures

目的 改良胸腰椎前路固定技术以减少失血量、提高椎体一次性置钉成功率。 方法 仅结扎骨折椎体术侧椎体血管 ,切除骨折椎相邻上、下椎间盘 ,保留大部分软骨终板后椎体置钉 ,取髂骨 ,再切除椎体行椎管减压 ,撑开骨折间隙行髂骨块结构性植骨 ,置放钢板矫形加压锁定。结果 采用此技术 ,治疗胸腰椎骨折 87例 ,其中新鲜骨折 76例 ,术中失血 4 0 0～ 80 0ml,平均5 6 0ml,手术时间 2 .5～ 3h ;陈旧性骨折 11例 ,术中失血 80 0～ 12 0 0ml,平均 10 80ml,手术时间 3.5～ 4h。脊椎后凸畸形完全矫正 81例 ,残余 5°～ 8°后凸畸形 4例 ,前凸畸形 2例。术后瘫痪基本恢复者 39例 ,部分恢复者 2 8例 ,小部分恢复者 9例 ,无恢复 11例。无一例术后神经症状加重。结论 改良胸腰椎前路操作技术可明显减少术中失血、缩短手术时间 ,提高了椎体一次性置钉的成功率。

Objective To modify the anterior fixation technique for thoracolumbar fractures so as to reduce blood loss and improve the success rate of the first vertebral screw implantation. Methods Only surface artery of the injured vertebrae was ligated and the discs adjacent to the burst vertebra excised. Then,the mass autograft ilium was harvested with most cartilage terminal lamina left. The bursted vertebra was resected so that the vertebral canal could be decompressed thoroughly. Structural ilium graft was performed,followed by Z-plate being placed and locked. Results The modified operative technique was used to treat 87 cases,of which 76 cases of fresh thoracolumbar fracture had hemorrhage capacity about 400-800 ml (average 560 ml) as well as operation time for 2.5-3 hours,and 11 cases with old fractures had hemorrhage capacity about 800-1 200 ml (average 1 080 ml) as well as operative time for 3.5-4 hours. Eighty-one cases with kyphosis deformity was completely corrected,four cases had kyphosis deformity of 5°-8° and two lordosis. A total of 39 cases with post-operative paralysis basically recovered,28 partially recovered,nine recovered fractionally and 11 was beyond recovery. No aggravation was found in post-operative nerve syndrome. Conclusions The modified anterior fixation technique is excellent in reducing blood loss,shortening the operation time and increasing the success rate of the primary vertebral screw implantation. [