后路椎体次全切减压植骨内固定修改稿讲义.docVIP

后路椎体次全切减压重建与前后路联合手术治疗严重胸腰椎三柱骨折不全瘫 温州医科大学附属温岭医院 温岭第一人民医院脊柱外科(317500) 李宏杰 张文斌 方春养 莫挺挺 【摘要】 目的：比较后路椎体次全切减压重建与前后路联合手术治疗严重胸腰椎三柱骨折的临床疗效，为术式选择提供依据。方法：回顾性分析2008年1月~2012年12月采用后路椎体次全切减压重建（A组）和前后路联合手术（B组）治疗严重胸腰椎三柱骨折不全瘫患者的临床和影像学资料。其中A组18例，男10例，女8例，损伤节段：T111例，T125例，L16例，L26例；B组15例，男9例，女6例，损伤节段：T111例，T125例，L15例，L24例。Frankel 分级评价神经功能。X 线片、CT 评估伤椎前缘高度恢复情况、Cobb 角的矫正情况、椎管减压范围及植骨融合情况，并观察手术并发症。结果：所有患者得到12～18 个月（平均16月）随访，A 组平均手术时间、术中出血量及术后引流量分别为200min 、1100ml 及400ml；B 组为290min、1500ml 及900ml，两组差异有统计学意义（p0.05）。伤椎前缘高度及后凸Cobb角两组术后较术前均有明显的改善，但两组之间改善无统计学差异(p0.05)。两组术后Frankel神经功能评分较术前均有1级或1级以上的改善，两组之间术后神经功能的恢复比较无统计学意义(p0.05)。结论：后路椎体次全切减压、重建、椎弓根钉内固定通过一个切口完成了减压重建固定的效果，临床疗效与前后路手术相似，但创伤明显减少，是一种是安全有效的手术方式。 【关键词】胸腰椎；骨折；手术入路；疗效 Subtotal vertebrectomy，decompression and reconstruction of spine through posterior approach and operation by anterior and posterior united approach in treatment of severe thoracolumbar fracture with incomplete paralysis./LI Hongjie, ZHANG Wenbing, FANG Chunyang, et al. Department of Spine Surgery ,Wenling hospital affiliated to Wenzhou medical university, Zhejiang, 317500, P.R.China. 【Abstract】 Objective To compare the surgical results of subtotal vertebrectomy，decompression and reconstruction of spine through posterior approach and operation by anterior and posterior united approach in treatment of severe thoracolumbar three column fracture with incomplete paralysis，and to provide the basis for the operation of the pre-selection．Methods Clinical and radiographic results of subtotal vertebrectomy，decompression and reconstruction of spine through posterior approach(A group) and operation by anterior and posterior united approach(B group) in treatment of severe thoracolumbar three column fracture with incomplete paralysis were analyzed retrospectively from January 2008 to December 2012．.Group A had 18 cases (18 males and 10 females). The fractures were located at T11 in 1、T12 in 5、L1 in 6 and L2 in 6. Group B had 15 cases (9 males and 6 females). The fractures were located