关于胸腰段椎体爆裂性骨折后缘骨块手术处理探析.docVIP

关于胸腰段椎体爆裂性骨折后缘骨块手术处理探析 　 作者：邹方亮，杨新军，史成富，谭军，李立钧，周炜 【摘要】 ［目的］探讨胸腰段椎体爆裂性骨折后缘骨块的处理、其前后路手术适应证、优缺点及治疗效果。［方法］通过对2002年7月～2006年6月共收治高能量损伤致胸腰段椎体爆裂性骨折患者38例进行了回顾性分析，其中，男24例，女14例，男：女为1.7：1，年龄21～62岁，平均39.5岁，按Dennis分类，前柱损伤为14例，前、中柱损伤为24例，合并神经系统损伤为68％，按Frankel分级，其中：A级6例，B级6例，C级10例，D级8例，E级8例。对其后缘骨块处理进行了总结，分析不同病例的影像学资料，分别采用前后路手术方法进行治疗，通过复查术后胸腰椎的功能和影像学资料来判定临床治疗效果。［结果］38例均获随访，随访时间为12～18个月，平均随访14.4个月，两组结果进行比较：其中20例患者采用前方入路，术后平均2周下地活动，术后腰背部疼痛基本消失，神经功能改善按Frankel分级，都有1～3级的改善，X线片显示椎体高度达解剖复位，椎体后缘骨块完全复回至椎体内，无椎管压迫，脊柱植骨融合率达100％，无椎体高度塌陷。18例患者采用后路手术，有4例椎体骨折复位不理想，椎体高度由术前48.14％恢复至术后的92.14％,残留腰背部疼痛、后凸畸形、神经功能恢复不全。骨折全部愈合，术后腰痛基本消失，椎体高度恢复好，脊柱融合好，神经功能按Frankel分级均有1～3级的改善。［结论］对于胸腰段椎体爆裂骨折后缘骨块处理均应用切开复位椎管减压植骨融合内固定手术治疗。手术可提供良好固定，降低并发症，取得良好治疗效果。 【关键词】 胸腰段； 爆裂性骨折； 后缘骨块； 手术处理 Abstract：［Objective］To discuss the surgical treatment, the proper application, and the respective effect of the therapy of burst fracture in the posterior marginal vertebral bone block and the thoraco-lumbar vertebra.［Method］Thirty-eight patients with thoraco-lumbar burst fracture induced by high energy injury were hospitalized from July 2002 to June 2006.Through the were assessed application of section and ORIF(open reduction internal fixation),decompression of vertebral canal by bone grafting and fusion, the clinical effect of therapy by rechecking the postoperative thoracic-lumbar function and radiographic information.［Result］All the 38 patients were followed up for 12-18 months (average 14.4 months).The fracture were all healed and lumbar pain disappeared, the vertebral height restored, and well-fused.According to Frankel ranking,the neurological function recovered,with the degree varying from 1 to 3.［Conclusion］It’s a good method to apply the open and reduction, decompression of spinal canal with bone grafting and fusion operation. This kind of operation can get perfect treating effect by providing good fixation and reducing the complications. Key words：thoraco-lumbar; burst fracture; posterior marginal vertebral bone block； operativ