医学论文-无神经损伤的胸腰椎骨折的手术治疗.docVIP

医学论文-无神经损伤的胸腰椎骨折的手术治疗 【摘要】? ［目的］探讨无神经损伤的胸腰椎骨折手术治疗的效果及优点。［方法］2003年7月—2006年7月，手术治疗无神经损伤的A、B型胸腰椎骨折(按AO分类)23例。术前椎体前缘高度丧失均在40％以上；70％患者CT扫描椎管内有骨折块占位。均采用后路椎弓根螺钉内固定系统复位固定，行横突间及椎板间植骨融合术。评价骨折复位及植骨融合情况。［结果］随访时间14～48个月，平均28个月。术后椎体前缘高度及椎间角较术前明显增加(P0.05)：术后3、6、12个月与术后即刻相比无显著性差异(P0.05)。术前椎管狭窄率平均38％，术后3个月为12％，较术前明显减少(P0.05)。术后1年植骨融合率为81％。［结论］无神经损伤的胸腰椎骨折手术治疗有助于恢复椎体高度、纠正成角畸形、恢复椎管容积、防止继发性神经损伤及重建脊柱即刻稳定性。为了获得长期稳定性，应辅以植骨融合术。 【关键词】? 胸腰椎； 骨折；无神经损伤 　　Surgical treatment of thoracolumbar fracture without neurological deficit??? 　　Abstract：［Objective］To explore the clinical outcome and advantages of surgical treatment of thoracolumbar fracture without neurological defect.［Method］From July 2003 to July 2006, 23 cases of AO type A or type B thoracolumbar fracture without neurological defect were treated operatively. The anterior height of vertebral body lost more than 40% before operation, and 70% of the patients had an intracanal fragment.Transpedicular screw reduction and fixation were performed and bone fusion with inter transverse process and interlaminar bone graft were performed.［Result］The anterior height of vertebral body and the intervertebral body angle improved significantly after operation. And the rate of spinal stenosis decreased from 38% before operation to 12% 3 months after operation. 81% achieved bone fusion 1 year after operation.［Conclusion］The surgical treatment of thoracolumbar fracture without neurological deficit has the advantages of restoration of vertebral body height effectively, correction the deformity,restoration of the spinal volume and prevention the progressive of neurological deficit.In order to achieve longterm stability,bone fusion should be performed at the some time.??? 　　Key words：thoracolumbar;? fracture; without; urological deficit ??? 胸腰椎骨折常常会带来2个后果：(1)合并圆锥或马尾神经损伤，(2)出现脊柱成角畸形及不稳。合并神经损伤者需要手术治疗已达成共识，但对无神经损伤症状的严重胸腰椎压缩性及爆裂性骨折是否应行手术治疗及手术方法的选择，则一直有争议。本文总结了23例不伴神经损伤的胸腰椎骨折患者的手术治疗情况，报告如下。　　　1材料和方法 　　1.1? 临床资料??? ? 本组为自2003年7月—2006年7月经同一治疗组手术治疗的无神经损伤的胸腰椎