前外侧入路在胸腰段爆裂骨折中的临床应用

发布时间：2018-03-22 19:43

本文选题：前外侧入路　切入点：侧前方减压术　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨经前外侧入路行减压植骨融合内固定术治疗胸腰段爆裂骨折合并神经损伤患者在后凸畸形矫正及维持、椎体高度恢复和保持、椎管减压效果、神经功能改善、临床治疗效果方面的手术优势。方法:经前外侧入路行侧前方减压植骨融合内固定术治疗胸腰段(T11-L2)爆裂骨折伴有神经症状的患者22例。根据影像资料,比较患者在术前、术后及末次随访中脊柱后凸角(°)、伤椎前缘高度压缩百分比(%)、椎管正中矢状径占比(%)的变化;有无继发后凸畸形、椎体高度丢失及内固定失效等情况。根据临床表现,比较患者术后与术前ASIA(美国脊髓损伤协会)脊髓损伤水平评分;术前、术后及末次随访的JOA(日本矫形外科学会)下腰痛评分,统计术后及末次随访改善率,比较术后与末次随访的优良率。结果:22例患者获得(18±7.2)个月随访,1例患者术后出现严重腹痛腹胀,对症治疗后好转;2例患者术后出现肋间神经支配区感觉障碍,神经营养药物治疗后1例恢复1例好转;所有患者均未出现其他并发症。在影响学指标变化上,脊柱后凸角:术前(20.53±4.05)°、术后(5.94±1.08)°、末次随访(6.56±0.98)°,术后与术前比较差异有统计学意义(P=0.01)、末次随访与术前比较差异有统计意义(P=0.01)、末次随访与术后比较差异无统计学意义(P=0.08);伤椎前缘高度压缩百分比:术前(51.18±7.67)%、术后(91.77±2.31)%、末次随访(90.55±4.28)°,术后与术前比较差异有统计学意义(P=0.01)、末次随访与术前比较差异有统计学意义(P=0.01)、末次随访与术后比较差异无统计学意义(P=0.14);椎管正中矢状径占比:术前(34.82±5.14)%、术后(3.16±0.58)%、末次随访(3.30±0.48)%,术后与术前比较差异有统计学意义(P=0.01)、末次随访与术前比较差异有统计学意义(P=0.01)、末次随访与术后比较差异无统计学意义(P=0.13)。所有患者在术后及随访中均未出现继发后凸畸形、椎体高度明显丢失及内固定失效的情况。在术后与术前ASIA评分比较上除2例术前ASIA评分为A级的患者无提高外,12例患者得到1级提高,8例患者得到2级提高。JOA评分改善率上术后优良患者14例,末次随访优良患者19例,末次随访优良率86.36%与术后优良率63.65%比较有明显提高。结论:经前外侧入路行侧前方减压植骨融合内固定术治疗合并神经损伤的胸腰段爆裂骨折解剖入路相对简单,避免损伤胸腔、腹腔器官减少手术并发症;能有效纠正和预防后凸畸形;恢复并维持椎体前缘高度;直视下椎管减压充分,钛网重建前中柱同时行后路内固定加强脊柱稳定性;患者神经功能恢复满意,生活质量提高,可作为治疗胸腰段爆裂骨折伴神经症状的有效手术方式。
[Abstract]:Objective: to investigate the treatment of thoracolumbar burst fracture with nerve injury through anterolateral approach with decompression, bone grafting and internal fixation in correction and maintenance of kyphosis, recovery and maintenance of vertebral body height, decompression of spinal canal and improvement of nerve function. Methods: 22 cases of thoracolumbar T11-L2) burst fracture with neurological symptoms were treated by anterior decompression and bone graft fusion and internal fixation via anterolateral approach. Changes of kyphosis angle (掳掳, compression percentage of anterior edge height of injured vertebrae, ratio of median sagittal diameter of spinal canal), secondary kyphosis, loss of vertebral body height and failure of internal fixation, etc. The scores of postoperative and preoperative ASIA (American Spinal Cord injury Association) spinal cord injury level, preoperative, postoperative and final follow-up of JOA( Japanese Orthopaedic Surgical Association) low back pain score were compared, and the improvement rates of postoperative and last follow-up were calculated. Results 22 patients received 18 卤7.2 months follow-up, 1 patient developed severe abdominal pain and abdominal distension, 2 patients improved after symptomatic treatment and developed sensory disturbance of intercostal innervation area. 1 case recovered after neurotrophic drug treatment, 1 case improved, no other complications occurred in all patients. The kyphosis angle was 20.53 卤4.05 掳before operation, 5.94 卤1.08 掳after operation, and 6.56 卤0.98 掳at the last follow-up. The difference between postoperative and preoperative was statistically significant (P < 0.01). The percentage of anterior height compression was 51.18 卤7.67 before operation, 91.77 卤2.31 after operation, and 90.55 卤4.28 掳at the last follow-up. There was a significant difference between postoperation and pre-operation, and there was significant difference between last follow-up and pre-operation. There was no significant difference between the last follow-up and postoperative. The ratio of the median sagittal diameter of the spinal canal was 34.82 卤5.14 before operation, 3.16 卤0.58 after operation, and 3.30 卤0.48 at the last follow-up. The difference between postoperative and preoperative was statistically significant (P 0.01). There was a significant difference between the last follow-up and preoperative, but there was no significant difference between the last follow-up and postoperative. There were no secondary kyphosis in all patients after operation and follow-up. The loss of vertebral height and the failure of internal fixation. In comparison with preoperative ASIA score, 12 patients received grade 1 improvement and 8 patients received grade 2 improvement, except for 2 patients with ASIA grade A before operation. The rate of improvement was good in 14 cases. There were 19 excellent patients at the last follow-up. The excellent and good rate of the last follow-up was 86.36% and the excellent and good rate was 63.65%. Conclusion: the anatomic approach for thoracolumbar burst fracture with nerve injury is relatively simple through anterolateral approach and lateral anterior decompression and bone grafting fusion fixation. It can effectively correct and prevent kyphosis, restore and maintain the height of the anterior edge of vertebral body, decompression of vertebral canal under direct vision, reconstruction of anterior and middle column of titanium mesh and internal fixation of posterior approach to strengthen the stability of spine. The patients with satisfactory recovery of nerve function and improved quality of life can be used as an effective surgical method for the treatment of thoracolumbar burst fracture with neurological symptoms.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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