前路减压植骨内固定治疗胸腰椎爆裂骨折的疗效分析

Anterior decompresion and instrumentation with the Antares device and titanic cage for the treatment of instable thoracolumbar burst fractures

中文关键词:  胸腰椎  爆裂骨折  前入路  内固定

英文关键词:Thoracolumbar vertebrae  Burst fractures  Anterior  Internal fixation

中文摘要:

  【摘要】　目的：探讨经前路减压植骨内固定治疗胸腰椎爆裂骨折的适应证和疗效。方法：2005年1月～2007年6月，应用前路减压、钛网植骨、单节段或双节段内固定治疗Denis分类不稳定的胸腰椎爆裂骨折患者43例，男28例，女15例，平均年龄37.3岁。骨折部位：T12 9例，L1 22例，L2 6例，T12合并L1、L5 1例，T12、L1 2例，L1、L2 3例。骨折Denis分类：A型21例，B型18例，E型4例。31例伴脊髓神经功能损害，Frankel分级A级4例，B级6例，C级8例，D级13例。经胸入路12例，经胸膜外腹膜后入路25例，经腹膜后入路6例；16例行单节段固定，27例行双节段固定。均采用Antares脊柱内固定系统固定，随访观察治疗效果。结果：所有患者顺利完成手术，单节段固定平均手术时间为150±70min，出血量平均428±85ml；双节段固定平均手术时间为260±78min，出血量平均830±126ml。胸腔引流时间3~5d，平均3.1d。伤口均一期愈合，3例合并肺部感染，治疗后均痊愈。单节段组融合节段平均后凸角5.2°±3.3°（2.1°～10.4°），平均矫正率为（63.9±1.4）%。双节段组融合节段平均后凸角4.9°±2.0°（2.5°～11.2°），平均矫正率为（66.2±2.2）%。术后随访6～28个月，平均16.4个月，无内固定失败，矫正度无明显丢失，均获得良好植骨融合。末次随访时16例患者神经功能有1级以上改善。结论：前路手术治疗不稳定性胸腰椎爆裂骨折减压彻底，使用Antares脊柱内固定系统操作简便、固定牢靠。

英文摘要:

  【Abstract】 　Objective：To discuss the efficacy and indication of anterior decompression and fixation for the treatment of instable thoracolumbar burst fractures.Method：Between January 2005 and June 2007，Fourty-three cases with fractures of the thoracolumbar spine were treated with Antares device.There were 28 males and 15 females，with the average age of 37.3 years.The fracture located at T12 in 9 cases，L1 in 22 cases，L2 in 6 cases，T12，L1 and L5 in 1 case，T12 and L1 in 2 cases，L1 and L2 in 3 cases.The fracture was evaluated by Denis classification：A in 21 cases，B in 18 cases，E in 4 cases.31 cases were associated with neurological injury，Frankel A in 4 cases，B in 5 cases，C in 8 cases，D in 13 cases.12 cases were treated by transthoracic approach，25 cases by extrapleural and retroperitoneal approach，6 cases by retroperitoneal approach.16 cases with monosegmental fixation，27 cases with bisegmental fixation. Antares device was used for all cases.All patients were followed-up and their clinical outcomes were determined.Result：All operations were successfully completed.The average time with monosegmental fusion was 150±70min，the average blood loss was 428±85ml.The average time with bisegmental fusion was 260±78 hours，and average blood loss was 830±126ml. the thoracic cavity drainage time was 3.1d，ranged from 3 to 5d.The wounds obtained primary intention healing，but 3 cases were complicated with pulmonary infection，which cured by using antibiotics，the average postoperative kyphotic angle in monosegmental was 5.2°±3.3°（2.1°-10.4°），with an average corrective rate of（63.9±1.4）%.The average postoperation kyphotic angle in bisegmental was 4.9°±2.0°（2.5°-11.2°），with an average corrective rate of （66.2±2.2）%.During the follow-up，neither internal fixations failure，nor loss of the correction were observed and all fusions were successful.Postoperative neurological fuctions were improved above 1 grade at the last follow-up.Conclusion：Anterior decompression and fixation with Antares spinal systems provides a simple and effective technique for the surgical treatment of instable thoracolumbar burst fractures，which demonstrates the evidences of a through decompression，stable fixation and easy handling as well by this method.