后正中入路治疗严重胸腰椎损伤.doc

后正中入路治疗严重胸腰椎损伤摘 要 目的：探讨严重胸腰椎损伤的临床特点，以及后正中入路复位固定的方法和疗效。方法：对2001年1月～2006年8月收治的43例胸腰椎椎间结构严重损伤或椎体、附件骨折伴椎体前方或侧方脱位患者的临床资料进行回顾性分析。30例采用全椎板减压、植骨融合及后路椎弓根螺钉固定。13例采用半椎板减压，对侧椎板间及双侧关节突关节植骨融合椎弓根螺钉固定。结果：全部病例随访6~36个月，平均16个月。3例患者术后出现脑脊液漏，经保守治疗治愈。随访时X线片显示所有患者骨性融合，无内固定松动、断裂等并发症。20例Frankel分级A级的患者术后神经功能无改善，但可在轮椅帮助下部分生活自理，8例由B级恢复到C级，15例由C级恢复至D级。结论：完整保留未损伤的关节突关节，结合复位、植骨融合及椎弓根后路固定治疗严重胸腰椎损伤，可获得较高的早期稳定性及后期骨性融合率。 关键词 脊柱脊髓损伤 后正中入路 疗效 Abstract Objective：To investigate the clinical characteristics，fixation and efficiency of the severe trauma of thoracic and lumbar vertebra by posterior approach.Methods：The clinical data of 43 patients with major injury of intervertebral structure，appendix fracture of vertebra and severe anterolateral dislocation of vertebra from Jan.2001 to Aug.2006 were reviewed retrospectively.All the patients received operation，30 patients with reduction，laminectomy，fusion and instrumentation；13 patients with reduction，semi-laminectomy，fusion and instrumentation.Result：43 patients were followed-up for an average of 16 months (range 6 to 36 months).3 cases with leakage of cerebrospinal fluid post-operation were cured by conservative treatment in one week.All the patients have good fusion and stabilization in the last follow up.No complication of loosening or breakage of interfixation.According to Frankel classify，paralysis not improved in 20 patients with Frankel level A，but improved in 23 patients with one Frankel level.Conclusion：Stability and fusion could be achieved by reduction，graft and fixation of the pedicle screw through posterior approach when the zygapophysial joints were without fracture. Key words Spinal Cord Injury；Posterior Approach；Efficiency 重物挤压伤、交通伤等高能量损伤等常导致严重的脊柱脊髓损伤，以致椎体的吻尾侧椎间盘及椎体间韧带损伤或断裂、棘上韧带、棘间韧带以及关节突关节损伤，出现单一或数个椎体发生严重失稳现象。对我院2001年1月～2006年8月收治的43例椎间结构严重损伤或椎体、附件骨折伴椎体前方或侧方脱位患者的临床资料进行回顾性分析，观察严重胸腰椎损伤的手术复位、植骨融合及内固定方法及疗效。 资料与方法 一般资料：本组43例，男31例，女 12例；年龄24～58岁，平均36岁。致伤原因：重物挤压伤14 例，交通伤29例。损伤部位均位于腰椎，其中单节段37例(L?1节段9例，L?2节段6例，L?3节段10例，L4节段4例，L?5节段8