后路椎体次全切钛网植入内固定治疗胸腰椎爆裂骨折

发布时间：2018-07-07 18:44

本文选题：胸腰椎骨折 + 椎体次全切　；参考：《创伤外科杂志》2015年05期

【摘要】：目的探讨经后路椎体次全切钛网植骨融合椎弓根钉内固定治疗胸腰椎爆裂骨折的临床疗效。方法 2012年6月~2014年6月,笔者运用胸腰椎损伤评分系统(TLICS评分)和脊柱载荷评分系统(LSC评分),对纳入的35例成人[男性21例,女性14例;年龄26~45岁,平均(37.4±6.3)岁]胸腰椎爆裂骨折,采用一期经后路椎弓根内固定撑开复位,伤椎椎体次全切,椎管减压,钛网植骨融合手术。采用美国脊柱损伤学会分级(ASIA)进行神经功能评估,通过X线和CT评估术前、术后及末次随访时伤椎椎体高度、椎管占位情况和椎间融合情况。结果手术均顺利完成,6例术后并发脑脊液漏,余无严重并发症发生。所有病例均获随访,随访时间平均为(15.3±6.8)个月,除5例患者术前神经功能为A级外,余30例患者神经功能均有不同程度提高。术后影像学显示减压及复位效果满意,末次随访时植骨全部获得骨性融合,无假关节形成。结论经后路椎体次全切减压,前中柱重建脊柱序列,固定融合治疗胸腰椎爆裂骨折手术操作相对简便,减压彻底,并发症少,有效恢复椎体高度及椎管容积,是胸腰椎骨折的一种有效治疗方法。
[Abstract]:Objective to investigate the clinical effect of posterior subtotal titanium mesh bone grafting and pedicle screw fixation in the treatment of thoracolumbar burst fracture. Methods from June 2012 to June 2014, the authors used the thoracolumbar injury score system (TLICS) and the spinal load scoring system (LSC) to evaluate 35 adults (21 males and 14 females, aged 2645 years). The average age of thoracolumbar burst fracture was (37.4 卤6.3) years old. The thoracolumbar burst fracture was reduced by posterior pedicle fixation, the injured vertebrae was subtotal, the decompression of vertebral canal was performed, and the titanium mesh bone graft fusion was performed. The nerve function was evaluated by the American Spinal injury Association (Asia) classification. The height of the injured vertebral body, the space occupying of the spinal canal and the intervertebral fusion were evaluated by X-ray and CT before, after and at the last follow-up. Results 6 cases of postoperative cerebrospinal fluid leakage were successfully completed, and no serious complications occurred. All the patients were followed up, the average follow-up time was (15.3 卤6.8) months. The neurological function of the other 30 patients was improved in varying degrees except for 5 patients with A grade before operation. The postoperative imaging showed that the decompression and reduction were satisfactory. At the last follow-up, all the bone grafts were bony fusion, and no pseudoarthrosis was formed. Conclusion posterior subtotal decompression, anterior and middle column reconstruction of spine sequence and fixation fusion for thoracolumbar burst fracture are relatively simple, complete decompression, less complications, and effective recovery of vertebral body height and spinal canal volume. It is an effective treatment for thoracolumbar fracture.
【作者单位】：重庆医科大学附属第一医院骨科;
【分类号】：R687.3

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