摘要
目的探讨后路经一侧椎弓根脊椎部分切除减压与重建手术治疗严重胸腰椎三柱骨折的可行性及疗效。方法 2006年3月至2009年3月采用后路经一侧椎弓根脊椎部分切除减压与重建术治疗严重胸腰椎三柱骨折患者19例。术前进行载荷分享评分及神经功能分级,术后测量伤椎Cobb角并了解丢失情况,评估椎管减压范围、植骨块位置及愈合情况,评定神经功能恢复情况。结果 19例患者均一期完成手术,手术时间2.8～4.1h,平均3.4h,术中出血400～2100ml,平均880ml。术中无其他相关并发症发生。术后X线检查示Cobb角矫正12°～25°,平均19.8°。随访12个月以上,8例FrankelA级患者中,4例无神经功能恢复,4例恢复至B级;7例B级患者中,3例恢复至C级,3例恢复至D级,1例失访;4例C级患者中,3例恢复至D级,1例恢复至E级。随访中影像资料示植骨界面骨性融合,未发生内固定器或植骨块松脱、移位及断裂。结论经后路经一侧椎弓根脊椎部分切除减压与重建手术可以同时完成椎管彻底减压、前中柱重建,恢复脊柱三柱稳定,是治疗严重胸腰椎三柱骨折的可行方法之一。
Objective To study the feasibility and outcome of posterior one-side transpedicular partial spondylectomy to reconstruct and decompress thoracolumbar vertebra in treatment of three-column thoracolumbar spine fractures. Methods Posterior one-side transpedicular partial spondylectomy was performed for 19 patients with three-column thoracolumbar spine fractures from March 2006 to March 2009,with the loading on thoracolumbar vertebra scored and neurologic function graded before operation. Loss of Cobb angle of injured vertebra was detected,decompression range of vertebral cannel,position and fusion of bone grafts,as well as recovery of neurologic function were evaluated after operation. Results The procedure was successfully performed in all the patients at one time. The operation time was 3. 2 -4. 1 h （ mean 3. 8 h）. The volume of blood loss during operation was 400 -2 100 ml （ mean 880 ml）. No operation-related complication occurred. X-ray examination showed that the correction of Cobb angle was 12° -25° （ mean 19. 8°）. The patients were followed up for more than 12 months. Among the 8 Frankle A patients,neurologic function did not recover in 4 and was recovered to Frankle B in 4. Among the 7 Frankle B patients,neurologic function was recovered to Frankle C in 3,and follow-up was lost in 1. Among the 4 Frankle C patients,neurological function was recovered to Frankle D and E in 3 and 1,respectively. Fusion of bone grafts and vertebrae was found in 15 patients. No looseness,shift and fracture of bone grafts and internal fixers was found. Conclusion Posterior partial one-side transpedicular spondylectomy can reconstruct and decompress thoracolumbar vertebra,recovering the stability of the three-column spine,and is thus one of the feasible procedures for severe three-column thoracolumbar spine fractures.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2010年第11期1229-1231,共3页
Journal of Third Military Medical University
关键词
胸腰椎
骨折
脱位
手术
thoracolumbar vertebra
fracture
dearticulation
operation
