摘要
目的探讨经椎弓根内侧入路减压复位在治疗胸腰段椎体爆裂骨折合并脊髓神经损伤中的临床疗效。方法回顾性分析2012年8月—2018年12月陆军军医大学大坪医院脊柱外科收治的胸腰段椎体爆裂骨折合并脊髓神经损伤患者76例,男性47例,女性29例;年龄17~61岁,平均35.6岁。骨折AO分型:A1.3型43例,A2.1型19例,A2.2型7例,A3.1型5例,A3.2型2例。按脊髓损伤程度分为完全性脊髓损伤组5例、不完全性脊髓损伤组71例;根据美国脊髓损伤学会(ASIA)感觉评分和运动评分进行评估,所有患者行后路切开经椎弓根内侧入路减压复位、椎弓根钉棒系统内固定及后外侧植骨融合治疗,均于术前、术后末次随访12个月摄脊柱正侧位X线片和CT片,通过术前、末次随访伤椎椎体前缘高度恢复率、Cobb角、椎管侵占率、ASIA评分4个主要指标评估临床疗效。结果所有患者随访12个月,未发生内固定物断裂及椎体前缘高度丢失等并发症;椎体前缘高度恢复率:术前(47.3%±9.8%),术后12个月(87.1%±4.7%),差异有统计学意义(P<0.05);Cobb角:术前(29.3°±5.8°),术后12个月(6.3°±2.8°),差异有统计学意义(P<0.05);椎管侵占率:术前(29.5%±6.7%),术后12个月(11.3%±5.8%),差异有统计学意义(P<0.05);完全性脊髓损伤组感觉评分:术前(150±17)分,术后12个月(175±16)分;运动评分:术前(47±14)分,术后12个月(79±11)分,差异均有统计学意义(P<0.05);不完全性脊髓损伤组感觉评分:术前(167±21)分,术后12个月(186±13)分;运动评分:术前(71±15)分,术后12个月(82±14)分,差异均有统计学意义(P<0.05)。结论经椎弓根内侧入路减压复位、椎弓根钉棒系统内固定治疗胸腰段椎体爆裂骨折能有效减压、恢复椎体高度、促进脊髓神经功能恢复,临床疗效良好。
Objective To investigate the clinical effect of decompression reduction via the medial approach of the pedicle in the treatment of thoracolumbar vertebral burst fractures with spinal nerve injury.Methods A retrospective analysis was performed on 76 patients(47 males and 29 females,aged 17 to 61 years,average 35.6 years)with thoracolumbar vertebral burst fractures and spinal nerve injury in our department from Aug.2012 to Dec.2018,including 43 cases of type A1.3,19 cases of type A2.1,7 cases of type A2.2,5 cases of type A3.1 and 2 cases of type A3.2.There were 5 cases in the complete spinal cord injury group and 71 cases in the incomplete spinal cord injury group.The patients were evaluated with the ASIA sensory score and the exercise score consistently.In this study,all the patients were treated with the posterior approach decompression reduction via the medial approach of the pedicle,by which the internal fixation of pedicle screw rod system were employed and posterolateral bone graft fusion was performed.At 12 months preoperatively and postoperatively the X-ray and CT of the spine were obtained to evaluate the therapeutic efficacy by four major indexes including the recovery rate of the anterior edge of the vertebral body,the Cobb angle,the spinal canal invasion rate,and the ASIA score of the spinal cord injury.Results All patients were followed up for 12 months,and there was no complication such as internal fixation failure or loss of anterior vertebral height recovery.The recovery rate of the anterior edge of the vertebral body was(47.3±9.8)%preoperatively and(87.1±4.7)%at 1 year postoperatively,with a significant difference(P<0.05).The Cobb angle was significantly reduced from(29.3±5.8)°preoperatively to(6.3±2.8)°postoperatively(P<0.05)and the spinal canal invasion rate was significantly reduced from(29.5±6.7)%preoperatively to(11.3±5.8)%postoperatively(P<0.05).In the complete spinal cord injury group,the sensory score was(150±17)points preoperatively and(175±16)points at 12 months postoperatively;the exercise score was(47±14)points preoperatively and(79±11)points at 12 months postoperatively,and the differences were statistically significant(P<0.05).Whereas in the incomplete spinal cord injury group,the sensory score was(167±21)points preoperatively and(186±13)points at 12 months postoperatively;the exercise score was(71±15)points preoperatively and(82±14)points at 12 months postoperatively,and the differences were statistically significant(P<0.05).Conclusion Decompression and reduction through the medial pedicle approach and internal fixation of the pedicle screw and rod system can effectively reduce pressure,restore vertebral height,and promote spinal nerve function recovery in the treatment of thoracolumbar vertebral burst fracture.It is an ideal surgical approach for the treatment of thoracolumbar vertebral burst fractures with spinal nerve injury.
作者
张健
陈波
王钟
赵建华
姜复龄
ZHANG Jian;CHEN Bo;WANG Zhong;ZHAO Jian-hua;JIANG Fu-ling(Department of Spine Surgery,Army Medical University,Chongqing 400042,China)
出处
《创伤外科杂志》
2020年第1期10-13,共4页
Journal of Traumatic Surgery
关键词
胸腰椎爆裂性骨折
脊髓损伤
椎弓根减压
thoracolumbar burst fracture
spinal cord injury
pedicle decompression
