临床医学论文-后路短节段固定融合术选择性治疗胸腰段爆裂性骨折.docVIP

　　 后路短节段固定融合术选择性治疗胸腰段爆裂性骨折 　　?????????????? 作者：刘鹏，李远安，赵建华，柳峰，刘明永，范伟力 【摘要】? 目的 探讨采用后路切开复位、短节段内固定、植骨融合术治疗胸腰段爆裂性骨折的适应证、外科措施、术后康复措施并观察临床疗效。方法 回顾性分析2003年6月～2006年12月期间接受后路切开复位、短节段内固定、植骨融合术的27例胸腰段爆裂性骨折患者资料。术前伤椎前缘高度为正常值的40％～65％，术前胸腰段后凸畸形为22°～44°。神经功能Frankel C级6例，D级9例，E级12例。手术固定伤椎上下各一个椎体，采用自体骨后侧或后外侧植骨。术后硬支具保护3～6个月。用Oswestry功能障碍指数评估腰背功能恢复情况。结果 平均随访18.3个月（12～31个月）。伤椎前缘高度平均恢复至正常值的87％（65％～100%），术后即刻后凸角度平均9°（0°～30°），最终随访的矫正丢失度平均3.7°（0°～6°）；植骨融合率为100％，无内固定失败者。术后Frankel评级平均提高1级，最终随访时Oswestry功能障碍指数平均11％（0％～40％）。结论 后路短节段固定融合术治疗急性不稳定型胸腰段爆裂性骨折,可获得满意的骨折复位和临床效果，术后硬支具保护有助于维持复位效果。 【关键词】? 胸腰椎骨折；内固定；融合术??? 　　Abstract:? Objective? To investigate the indication,operative management, postoperative rehablitation of burst fractures of thoracolumbar junction via posterior shortsegment fixation and fusion and to observe the clinical outcome.Methods? A retrospective study was designed and 27 patients of burst fractures of thoracolumbar junction between June 2003 and December 2006 were included.Preoperative loss of vertebral height ranged from 40％65％，kyphosis ranged from 22° to 44°.Neurological status was graded as C in 6 cases,D in 9 cases and E in 12 cases.Pedicle fixation was used at one level above and below the fracturred vertebrae and autogenous bone was used in posterior and posterolateral fusion procedures.Hard orthotic device was worn for 36 months postoperatively.Oswestry disability index was used to evaluate back function.Results? The average followup was 18.3 months（range 1231 months）.Postoperative loss of vertebral height averaged 87％（65％100%）.Kyphosis averaged 9°（0°30°） and correction loss averaged 3.7°（0°6°）.Fusion rate was 100％ and no failure occurred.Neurological status improvement averaged one grade.Oswestry disablility index at the final? followup averaged 11％（0％40％）.Conclusion? For acute unstable burst fracture of thoracolumbar junction,satisfactory clinical outcome and reduction of fracture could be achieved by posterior shortsegment fixation and fusion.Posterior h