单一后路减压联合前-中柱重建治疗严重胸腰椎爆裂性骨折

发布时间：2018-03-14 07:44

本文选题：胸腰椎　切入点：爆裂性骨折　出处：《安徽医科大学学报》2017年08期 　论文类型：期刊论文

【摘要】：目的探讨单一后路减压联合前-中柱重建治疗严重胸腰椎爆裂性骨折的临床效果。方法对29例胸腰椎爆裂性骨折患者进行回顾性分析,所有患者经单一后路手术进行减压、复位并行椎体前-中柱支撑重建。采用美国脊髓损伤学会评分来评判患者的神经功能状态。通过术前、术后1周、术后1个月及末次随访时的X线片测量患者的椎间高度及后凸Cobb角,以此来评估骨折复位及脊柱前-中柱的重建及维持情况。结果术中无重要血管以及医源性神经损害发生,亦无死亡病例。术后有2例合并腰背部皮肤挫伤的患者并发切口浅表感染,经扩创换药后愈合。患者术后神经功能除了6例A级的无恢复外,其他患者均较术前有不同程度的改善。患者术前、术后1周、术后1个月以及末次随访时的椎间高度分别为33.6、57.9、56.2、54.8 mm;后凸Cobb角分别为20.1°、4.3°、4.6°、5.1°。患者术后的椎间高度及后凸Cobb角均较术前有明显改善(P0.01);术后1周、术后1个月、末次随访时的椎间高度及后凸Cobb角之间差异无统计学意义。结论单一后路减压联合前-中柱重建治疗严重胸腰椎爆裂性骨折可以有效恢复和维持椎体间的高度,重建脊柱的稳定性,是一种安全有效的手术方式。
[Abstract]:Objective to investigate the clinical effect of single posterior decompression combined with anterior and middle column reconstruction in the treatment of severe thoracolumbar burst fracture. Methods 29 patients with thoracolumbar burst fracture were retrospectively analyzed. Reduction and reconstruction of anterior to middle column of vertebrae. Neurological function was evaluated by the American Society for Spinal Cord injury (Asci) score. The intervertebral height and kyphosis Cobb angle of the patients were measured by X-ray film at 1 month and the last follow-up, so as to evaluate the fracture reduction and the reconstruction and maintenance of the anterior and middle column of the spine. Results there was no significant vascular and iatrogenic nerve damage during the operation. There were also no cases of death. There were 2 cases complicated with skin contusion on the back of the lower back and complicated with superficial infection of incision, which healed after dilatation and change of dressing. The neurological function of the patients was not recovered except in 6 cases of grade A. The other patients were improved in varying degrees than before. The intervertebral height and kyphosis Cobb angle were 33.6 / 57.9 / 56.2mm and 20.1 掳/ 4. 3 掳/ 4. 6 掳/ 5. 1 掳respectively. The postoperative intervertebral height and kyphosis Cobb angle were significantly improved compared with those before operation (P 0. 01), 1 week after operation, 1 month after operation, 1 month after operation, 1 month after operation, 1 month after operation, 1 month after operation, 1 month after operation, the intervertebral height and kyphosis Cobb angle were significantly improved. There was no significant difference between intervertebral height and kyphosis Cobb angle at the last follow-up. Conclusion single posterior decompression combined with anterior and middle column reconstruction for severe thoracolumbar burst fracture can effectively restore and maintain the height of vertebral body. Reconstruction of spinal stability is a safe and effective surgical method.
【作者单位】：安徽医科大学第一附属医院骨科;
【基金】：安徽省自然科学基金面上项目(编号:1508085MH151)
【分类号】：R687.3

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