椎板开窗椎管减压治疗伴神经损伤胸腰椎爆裂骨折

发布时间：2019-04-27 20:24

【摘要】：目的探讨椎板开窗椎管减压治疗合并神经损伤胸腰椎爆裂骨折的手术效果。方法回顾性研究自2008-01—2013-06采用椎板开窗椎管减压、椎弓根钉内固定治疗的28例合并神经损伤的胸腰椎爆裂骨折。术后1周、12个月行X线片和CT检查,测量椎体前缘高度、椎管中矢径和椎管狭窄。末次随访时记录腰背痛VAS评分和神经功能Frankel分级恢复情况。结果 28例均获得平均20.1(18~36)个月随访。术后1周与术前比较,椎体前缘高度(t=27.040,P0.001)、椎管中矢径(t=22.620,P0.001)、椎管狭窄(t=20.470,P0.001)明显改善,差异有统计学意义(P0.05)。术后12个月与术后1周比较,椎体前缘高度少许丢失,差异有统计学意义(t=16.970,P0.001),但基本维持稳定;椎管中矢径(t=8.480,P0.001)、椎管狭窄(t=10.150,P0.001)进一步改善,差异有统计学意义(P0.05)。末次随访时,除2例完全性神经损伤外,不完全性神经损伤患者均有不同程度恢复,由术前分级(2.75±1.21)恢复至(0.86±1.30),差异有统计学意义(Z=-4.435,P0.001);腰背痛VAS评分为(2.25±0.17)分,较术前明显降低,差异有统计学意义(t=19.390,P0.001)。结论椎板开窗椎管减压、椎弓根钉内固定治疗合并神经损伤的胸腰椎爆裂骨折不仅保留了椎管结构和脊柱稳定性,而且可以使椎管得到有效减压。
[Abstract]:Objective to investigate the effect of laminar fenestration decompression in the treatment of thoracolumbar burst fracture with nerve injury. Methods 28 cases of thoracolumbar burst fracture complicated with nerve injury were treated with laminar fenestration decompression and pedicle screw internal fixation since 2008 / 01 / 2013 / 06. One week and 12 months after operation, X-ray and CT were performed to measure the height of anterior edge of vertebral body, middle sagittal diameter of vertebral canal and stenosis of spinal canal. At the end of the follow-up, the VAS score and Frankel grade recovery of the patients with low back pain and neurologic function were recorded. Results all the 28 patients were followed up for an average of 20.1 months (18 months). One week after operation, the anterior edge height (t = 27.040, P 0.001), the middle sagittal diameter (t = 22.620, P 0.001) and the stenosis (t = 20.470, P 0.001) of the vertebral canal were significantly improved (P0.05). Compared with 1 week after operation, the height of anterior edge of vertebral body was slightly lost (t = 16.970, P 0.001), but remained stable at the 12th month after operation (t = 16.970, P < 0.001). The middle sagittal diameter (t = 8.480, P 0.001) and stenosis (t = 10.150, P < 0.001) of the spinal canal were further improved, and the difference was statistically significant (P0.05). At the last follow-up, except for 2 patients with complete nerve injury, the patients with incomplete nerve injury recovered to different degrees, from (2.75 卤1.21) to (0.86 卤1.30), the difference was statistically significant (Z = 4.435, P < 0.01). P0.001); The VAS score of lumbago and back pain was (2.25 卤0.17), which was significantly lower than that before operation (t = 19.390, P 0.001). Conclusion the treatment of thoracolumbar burst fracture with nerve injury by laminar fenestration decompression and internal fixation with pedicle screw not only preserves the structure of spinal canal and spinal stability, but also can effectively decompress the spinal canal.
【作者单位】：无锡市第九人民医院骨科;
【分类号】：R687.3

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