后路椎体次全切除稳定性重建治疗不稳定胸腰椎爆裂骨折的并发症及处理措施

The complications and management of posterior three-column reconstruction in unstable thoracolumbar burst fracture

中文关键词:  脊柱骨折  胸腰椎  减压术  并发症

英文关键词:Spinal fractures  Thoracolumbar vertebrae  Decompression  Complication

中文摘要:

  【摘要】 目的：总结经后路椎体次全切除稳定性重建治疗不稳定胸腰椎爆裂骨折的并发症及其处理方法。方法：2009年4月~2014年11月采用后路椎体次全切除及稳定性重建治疗不稳定胸腰椎爆裂骨折患者97例，男74例，女23例，年龄26~68岁。其中重物砸伤29例，高处坠落伤47例，交通伤21例；陈旧性骨折12例。主要累及节段：T11 5例，T12 16例，L1 31例，L2 29例，L3 10例，L4 6例。回顾患者手术时间及出血量，总结术中、术后并发症发生情况和所采取的处理措施。结果：共有21例患者发生39例次并发症，其中术中大出血（＞1500ml）17例，一过性神经根损伤10例，神经根腋下撕裂2例，脑脊液漏3例，钛网位置不良5例，浅层感染2例。上述并发症分别通过术中和术后输血、补充血容量，使用神经营养药物、脱水剂和激素，术中修补硬膜囊、加压包扎，再次手术探查减压等处理措施后，均获得较好预后。21例患者均获得随访，随访时间12~53个月，平均23.27±3.10个月，神经症状在1周~3个月完全缓解，钛网植骨均获得愈合，无进一步移位，脑脊液漏均一期愈合。结论：经后路椎体次全切除稳定性重建治疗不稳定胸腰椎爆裂骨折具有一定的风险，需要对其并发症进行积极预防和应对，多数并发症通过正确处理能获得较好的预后。

英文摘要:

  【Abstract】 Objectives: To analyze the cause and treatment of the postoperative complications by using three-column reconstruction through single posterior approach for the treatment of unstable thoracolumbar burst fracture. Methods: Form April 2009 to November 2014, 97 patients with unstable thoracolumbar burst fractures were involved, among them there were 74 males and 23 females, aged 26-68 years old(33.1 in average). 29 cases suffered from bruise injury caused by heavy object, 14 suffered from falling injury and 21 suffered from vehicle accident injury, 16 were complicated with vital organ injury. 12 cases suffered from old fracture. T11 was involved in 5 cases, T12 in 16 cases, L1 in 31 cases, L2 in 29 cases, L3 in 10 cases and L4 in 6 cases. The intra- and post-operative complications were summarized, and the relevant management undertaken was evaluated. Results: 39 complications were noted in 21 cases. The causes were as follows, excessive blood loss(＞1500ml) in 17 cases, transient nerve root injury in 10 cases, nerve root rupture in 2 cases, cerebrospinal fluid leakage in 3 cases, mesh cage displacement in 3 cases, and superficial infection in 2 cases. All complications got good relief after surgical exploration, blood transfusion, Methylprednisolone and neurotrophic drugs, anti-infection and symptomatic treatment. All 21 patients were followed up from 2 to 53 months(average, 23.27±3.10 months), neurological complications recovered from 1 week to 3 months, bone graft fusion was achieved and cerebrospinal fluid leakage had been cured in 1 stage. Conclusions: The three-column reconstruction through single posterior approach is a safe and effective technique for the treatment of unstable thoracolumbar burst fracture. The complications should be managed cautiously, and the results are promising after proper intervention.