摘要
目的探讨胸腰段椎体骨折的手术治疗方法及其临床疗效。方法回顾性分析2003年1月至2010年12月我院76例新鲜胸腰段椎体骨折手术治疗病例。其中T113例,T1219例,L140例,L214例。根据AO胸腰椎骨折分类,A型骨折34例,B型骨折7例,C型骨折35例。术前脊髓损伤(american spinal injury association,ASIA)分级,A级14例,B级14例,C级38例,D级5例,E级5例。胸腰椎损伤分类及损伤程度评分系统(thoracolumbar injuryclassification and severity score,TLICS)评分均大于4分。采用后路减压固定后外侧植骨融合术66例,前路减压固定椎体间植骨融合10例,其中多节段固定31例,单节段固定45例。根据Oswestry功能障碍指数(oswestry disabilityindex,ODI)评分标准和脊髓损伤ASIA分级结合椎体压缩率、Cobb角和椎管狭窄率变化进行术前和术后的疗效评价,并对术前和术后椎体压缩率、Cobb角和椎管狭窄率进行统计学分析。结果 76例患者获得12～48个月随访,平均32个月。ODI术后平均手术改善率为62.5%,优良率为69.8%;术后脊髓损伤ASIA分级均有不同程度的改善;术后所有患者的椎体压缩率、Cobb角和椎管狭窄率均有明显改善,与术前相比差异均有统计学意义(P<0.05)。结论根据胸腰段椎体骨折患者病情和影像学检查结果,确定椎体骨折节段、损伤程度、AO分类及脊髓损伤严重程度等,选择适合的手术方法。术中椎管彻底减压,恢复和重建椎体高度,坚强稳定的内固定和植骨融合,可避免术后椎体高度丢失、内固定松动及断裂等并发症,获得较好的手术疗效。
Objective To investigate surgical approaches and clinical outcome of thoracolumbar spine fracture. Methods This study retrospectively examined 76 patients with fresh thoracolumbar spine fracture from January 2003 to December 2010 all of them were treated operatively. There were Tllfrectures in 3 cases,Tn in 19 cases,L1 in 40 cases ,L2 in 14 cases. According to AO classification thoracolumbar fractures ,there were 34 A type fracture, 7 B type fracture and 35 C type fracture. Based on American Spinal Injury Association （ASIA） spinal cord injury grade,there were 14 A, 14 B, 38 C, 5 D and 5E before treatment. 66 patients underwent decompressive laminectomy ,posterolateral thoracolumbar fusion and fixation, 10 underwent anterior decompressive ,interbody fusion and fixation. 31 were multitude segment and 45 were single segment pedicle screws fixation. Oswestry disability index （ODD ,ASIA spinal cord injury, vertebral body compression rate ,Cobbrs angle and vertebral canal stenosis rate levels were recorded before and after treatment ,the outcome were evaluated. Vertebral body compression rate ,Cobbrs angle and vertebral canal stenosis rate were analyzed before and after opration. Results 76 cases were followed up for 12-48 months,The average followed up period was 32 months. The mean postoperative improvement rate of ODI was 62.5% ,and excellent and good rate was 69.8%. ASIA spinal cord injury levels were improved to some extent before operation. The postoperative all patients vertebral body compression rate,Cobbrs angle and vertebral canal stenosis rate were obviously improved,and there was statistical significance between preoperature group and postoperature group in recovery rate （P〈0.05）. Conclusion Were evauated,furthermore,suitable operation methods should be chosen. The patients shall be treated with complete decompression of vertebral canal, reestablishment of the vertebral body height, stable fixation and bone graft fusion according to patientsrclinical symptom and radiology evaluatin ,the location,extent,segment and AO classification of thoracolumbar spine fracture and spinal cord injury grade.
出处
《实用骨科杂志》
2013年第1期4-7,共4页
Journal of Practical Orthopaedics
基金
首都医科大学基础-临床科研合作基金(2011JL45)
关键词
胸腰段
骨折
手术治疗
thoracolumbar
fracture
surgical treatment
