经后路单侧椎板间隙小开窗椎管减压椎体内植骨成形术治疗严重胸腰椎骨折的疗效分析

发布时间：2018-04-17 15:03

本文选题：胸腰椎骨折 + 植骨　；参考：《中华骨与关节外科杂志》2016年03期

【摘要】：背景:目前,对于严重的爆裂性胸腰椎骨折的手术入路、脊髓神经的减压和植骨重建椎体前中柱等问题的争议较多。目的:探讨后路经单侧椎管脊髓神经减压、椎体内植骨成形治疗严重胸腰椎骨折伴有重度椎管狭窄的术后疗效及影像学评估。方法:2010年6月至2014年6月我院收治64例McAfee分型中C、E型胸腰椎骨折伴有重度椎管狭窄患者。对其行后路椎弓根螺钉撑开复位、经单侧椎管脊髓神经减压、椎体内植骨成形术。术前、术后2周及1年后分别行X线、螺旋CT三维图像重建检查,部分患者追加MRI检查。所有患者均于伤后2周内完成手术。术后坐、行走时佩戴胸腰支具固定3个月。评价术前、术后及终末随访时椎体前缘和后缘高度、Cobb角、椎管正中矢状径及截瘫恢复情况。采用CT三维图像重建评价突入椎管骨块复位和植骨分布情况。结果:随访时间13~27个月,平均18.62个月。由骨折块移位造成的对硬膜囊和神经根的卡压减压较彻底,植骨分布较广泛、均匀。分别对比术后与术前、终末随访与术前的伤椎体前缘高度、Cobb角、椎体正中矢状径,均存在显著差异(P0.05),而终末随访与术后对比无显著差异(P0.05)。椎体后缘高度在各时间段比较均无显著差异(P0.05)。所有手术切口均一期愈合。术后无脑脊液漏、椎弓根钉棒断裂及松动等并发症发生。结论:后路椎弓根螺钉撑开复位、经单侧椎管脊髓神经减压、椎体内植骨成形术能让椎管获得直接、充分的减压,植骨分布广泛、均匀,能有效恢复伤椎高度及重建椎体强度,是一种解决胸腰椎骨折伴重度椎管狭窄的有效方法。
[Abstract]:Background: at present, decompression of spinal cord nerve and reconstruction of anterior and middle column of vertebral body are controversial for severe thoracolumbar fracture.Objective: to evaluate the effect and imaging evaluation of posterior decompression of unilateral spinal cord nerve and bone graft in the treatment of severe thoracolumbar fractures with severe spinal stenosis.Methods: from June 2010 to June 2014, 64 cases of thoracolumbar fracture with severe spinal canal stenosis in McAfee classification were treated in our hospital.The posterior pedicle screw was repositioned and decompressed by unilateral spinal cord nerve and bone graft was performed.Before operation, 2 weeks and 1 year after operation, X-ray and spiral CT were performed respectively, and some patients were examined with MRI.All patients completed the operation within 2 weeks after injury.Postoperative sitting, walking wearing chest and waist support fixed for 3 months.To evaluate the height of Cobb angle, the median sagittal diameter of spinal canal and the recovery of paraplegia.Ct three-dimensional image reconstruction was used to evaluate the reduction and distribution of bony bone into the vertebral canal.Results: the follow-up time was 13 ~ 27 months (mean 18.62 months).The compression and decompression of the dural sac and nerve root caused by the displacement of the fracture block is relatively thorough, and the bone graft distribution is wider and more uniform.There were significant differences in the height of the anterior edge of the injured vertebra and the median sagittal diameter of the vertebral body between postoperative and preoperative, and between the end follow-up and the operation, but there was no significant difference between the end follow-up and postoperative comparison.There was no significant difference in the posterior edge height of vertebrae in all time periods (P 0.05).All incisions were healed in the first stage.There was no cerebrospinal fluid leakage, fracture and loosening of pedicle screw.Conclusion: posterior pedicle screw distraction reduction, unilateral spinal nerve decompression and bone-grafting can make the vertebral canal decompression directly and fully, and the bone graft is widely distributed and uniform. It can effectively restore the height of injured vertebrae and reconstruct the strength of vertebral body.It is an effective method to solve thoracolumbar fracture with severe spinal canal stenosis.
【作者单位】：遵义医学院附属医院脊柱外科;
【基金】：贵州省科技厅科学技术基金课题(黔科合J字[2010]2179号) 遵义医学院博士启动基金课题(遵医院办发[2010]1)
【分类号】：R687.3

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