期刊文献+

改良前后路联合手术一期治疗腰椎骨折脱位 被引量:9

MODIFIED POSTERIOR-ANTERIOR OPERATION FOR TREATMENT OF SERIOUS LUMBAR FRACTURE AND DISLOCATION
下载PDF
导出
摘要 目的总结经肌间隙入路后路复位联合改良前路支撑植骨内固定术一期治疗腰椎骨折脱位的临床疗效。方法2002年1月-2006年2月,采用一期经肌间隙入路后路复位联合改良前路支撑植骨内固定术治疗腰椎骨折脱位24例。男17例,女7例;年龄22~69岁。高处坠落伤9例,车祸伤15例。损伤节段:L15例,L210例,L34例,L42例,L1、21例,L3、42例。AO分型:B型6例,C型18例;神经功能Frankel分级:A级5例,B级11例,C级7例,D级1例。评估术后神经功能恢复情况,行影像学检查,测定Cobb角。结果术后19例获随访,随访时间8~52个月,平均28.4个月。2例术前FrankelA级患者1例恢复至C级,1例无改善;9例B级患者,5例恢复至C级,2例恢复至D级,2例无改善;7例C级患者,5例恢复至D级,2例恢复至E级;1例D级患者恢复至E级。术前、术后3d及末次随访Cobb角分别为(-11.5±4.6)、(4.2±4.7)和(4.0±4.8)°,术后3d及末次随访Cobb角与术前比较,差异均有统计学意义(P<0.001);末次随访与术后3d比较差异无统计学意义(P>0.05)。影像学检查示融合位置良好,无植骨块(钛网)移位、沉降及断钉、断棒和松动等现象。结论经肌间隙入路后路复位联合改良前路支撑植骨内固定术治疗严重腰椎骨折脱位可一期完成复位、减压、植骨和内固定,最大程度保护了脊柱后柱结构的完整性,减少了对椎旁软组织进一步的损伤,手术时间短、术中出血少、内固定牢固,临床疗效满意。 Objective To evaluate the clinical outcomes of modified posterior-anterior operation in the treatment of serious lumbar fracture and dislocation. Methods From January 2002 to February 2006, 24 patients, 17 males and 7 females aged 22-69 years, underwent reduction of posterior spatium intermuscular approach combined with modified anterior operation. Nine cases were caused by falling and 15 by traffic accident, involving: L1 in 5 cases, L2 in 10 cases, L3 in 4 cases, L4 in 2 case, LI; in 1 case and L3,, in 2 cases. According to the Frankel grade, there were 5 cases for grade A, 11 for grade B, 7 for grade C and 1 for grade D. The recovery of neurological function was evaluated. The imageology examination was applied to evaluate the condition of internal fixation and bone union. The Cobb' s angle was measured by X-ray film before operation, 3 days after operation and at the final follow-up, and the difference was estimated. Results Nineteen patients were followed up for 8-52 months, 28.4 months on average. Among the 2 cases of grade A, one improved to C and the other had no improvement. Among the 9 cases of grade B, 5 improved to C, 2 improved to D, and other two had no improvement. Among the 7 cases of grade C, 5 improved to D and 2 improved to E. One case of grade D improved to E. The average Cobb' s angle was (-11.5 ± 4.6)^o preoperatively, (4.2 ± 4.7)^o 3 days after operation and (4.0 ± 4.8)^o at the final follow-up, indicating there was a significant difference between preoperation, 3 days after operation and the final follow-up (P 〈 0.001), but no significant difference between 3 days after operation and the final follow-up (P 〉 0.05). The position of internal fixation was good during follow-up. The complications such as disruption, loosening and collapse were not observed. Conclusion Reduction of posterior spatium intermuscular approach combined with modified anterior operation in the treatment of serious lumbar fracture and dislocation could complete the reduction, decompression, grafting and internal fixation in one stage, and protect the paraspinal soft tissue and minimize the trauma caused by surgery. It has the merits of short time of operation, small amount of intraoperative hemorrhage, solid union of internal fixation and satisfactory clinical outcome.
出处 《中国修复重建外科杂志》 CAS CSCD 北大核心 2008年第8期910-913,共4页 Chinese Journal of Reparative and Reconstructive Surgery
基金 浙江省科技厅重点项目(2006C23029)~~
关键词 改良前后路联合手术 腰椎 骨折脱位 Modified posterior-anterior operation Lumbar Fracture and dislocation
  • 相关文献

参考文献18

  • 1Wook K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg(Am), 2003, 85-A(5): 773-781.
  • 2Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine, 2004, 29(7): 803-814.
  • 3Ferguson RL, Allen BL Jr. A mechanistic classification of thoracolum- bar spine fractures. Clin Orthop Relat Res, 1984,(189): 77-88.
  • 4Yu SW, Fang KF, Tseng IC, et al. Surgical outcomes of short-segment fixation for thoracolumbar fracture dislocation. Chang Gung Med J, 2002, 25(4): 253-259.
  • 5卢文灿,仉建国,邱贵兴.胸腰椎骨折的治疗[J].中华骨科杂志,2007,27(3):221-225. 被引量:29
  • 6Sasso RC, Best NM, Reilly TM, et al. Anterior-only stabilization of threecolumn thoracolumbar injuries. J Spinal Disord Tech, 2005, 18: 7-14.
  • 7Suwa H, Hanakita J, Ohshita N, et al. Postoperative changes in paraspinal muscle thickness after various lumbar back surgery procedures. Neurol Med Chir (Tokyo), 2000, 40(3): 151-155.
  • 8LaRocca H, Macnab I. The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg (Br), 1974, 56B(3): 545-550.
  • 9Song J, Park Y. Ligament-sparing lumbar microdiscectomy: technical note. Surg Neurol, 2000, 53(6): 592-597.
  • 10Wessberg P, Wang Y, Irstam L, et al. The effect of surgery and remodelling on spinal canal measurements after thoracolumbar burst fractures. Eur Spine J, 2001, 10(1): 55-63.

二级参考文献41

  • 1夏群,徐宝山,张继东,付国成.胸腰椎爆裂骨折手术入路的选择[J].中华骨科杂志,2004,24(12):718-722. 被引量:121
  • 2杨惠林,唐天驷,朱国良,洪天禄,许立,陈荣发,郑祖根.胸腰椎骨折经椎弓根内固定治疗中的失误和并发症的分析[J].中华骨科杂志,1996,16(6):356-359. 被引量:155
  • 3McLain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine, 2006, 31(11 Suppl): 70-79.
  • 4Shaffrey CI, Shaffrey ME, Whitehill R, et al. Surgical treatment of thoracolumbar fractures. Neurosurg Clin N Am, 1997, 8: 519-540.
  • 5McAfee PC, Levine AM, Anderson PA. Surgical management of thoracolumbar fractures. Instr Course Lect, 1995, 44: 47-55.
  • 6Knop C, Bastian L, Lange U, et al. Complications in surgical treatment of thoracolumbar injuries. Eur Spine J, 2002, 11: 214-226.
  • 7Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine, 2001, 26: 1038-1045.
  • 8Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine, 1983, 8: 817-831.
  • 9Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res, 1984, (189):65-76.
  • 10Singh K, Vaccaro AR, Eichenbaum MD, et al. The surgical management of thoracolumbar injuries. J Spinal Cord Med, 2004, 27: 95-101.

共引文献28

同被引文献56

引证文献9

二级引证文献51

相关作者

内容加载中请稍等...

相关机构

内容加载中请稍等...

相关主题

内容加载中请稍等...

浏览历史

内容加载中请稍等...
;
使用帮助 返回顶部