改良270°椎管减压椎体前中柱重建治疗严重胸腰椎骨折

Modified 270° spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column for severe thoracolumbar vertebral fractures

中文关键词:  胸腰椎骨折  椎管减压  内固定  椎弓根螺钉

英文关键词:Thoracolumbar fractures  Spinal canal decompression  Internal fixation  Pedicle scerw

中文摘要:

  【摘要】 目的：探讨经后路一期椎弓根螺钉固定、改良270°椎管减压、椎体前中柱重建治疗严重胸腰椎骨折的可行性与临床疗效。方法：2011年1月～2013年12月共治疗严重胸腰椎骨折21例，其中男15例，女6例；年龄20～64岁（36.1±14.8岁）。致伤原因：高处坠落伤13例，车祸伤6例，重物砸伤2例；致伤部位：T11/12 2例，T12/L1 6例，L1/2 7例，L2/3 4例，L2～L4 1例，L3/4 1例。AO分型：B2型13例，C型8例。均采用一期椎弓根螺钉固定、改良270°椎管减压、钛网植骨重建椎体前中柱治疗。比较术前、术后伤椎前缘高度、损伤部位Cobb角和椎管骨块占位率，观察植骨融合、椎管重建和内固定情况。采用ASIA 2000分级标准评定脊髓神经功能恢复情况。结果：手术时间120～180min（145±19.2min）；术中出血800～2200ml（1320±476.5ml）；术后切口引流液250～580ml（398±127.5ml）。术后切口无感染，无脑脊液漏、脊髓神经损伤或脊髓神经功能恶化病例。20例患者获得随访，随访时间12～36个月（21.5±9.7个月）。术后椎体前缘高度、脊柱Cobb角和椎管占位与术前比较差异均有统计学意义（P<0.05），末次随访时与术后比较差异均无统计学意义（P>0.05）。植骨均获得融合，椎管减压彻底，未出现椎弓根螺钉系统松动、断裂或钛网移位等现象。末次随访时脊髓神经功能除1例A级无变化外，其余均有1～2级的恢复。结论：经后路一期椎弓根螺钉固定、改良270椎管减压并椎体前中柱重建治疗严重胸腰椎骨折安全、可行，并且椎管减压彻底，可以维持脊柱良好的稳定性，获得满意的短期临床疗效。

英文摘要:

  【Abstract】 Objectives: To explore the feasibility and clinical efficacy of modified 270° spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column for severe thoracolumbar vertebral fractures. Methods: A total of 21 patients with severe thoracolumbar vertebral fractures were treated from January 2011 to December 2013. There were 15 males and 6 females, with an average age of 36.1±14.8 years(range, 20 to 64 years). The cause of injury included falling injury in 13 cases, traffic accident injury in 6 cases, crush injury in 2 cases. The lesion site included T11/12 in 2 cases, T12/L1 in 6 cases, L1/2 in 7 cases, L2/3 in 4 cases, L2-L4 in 1 case and L3/4 in 1 case. According to the AO classification, there were 13 cases of type B2, 8 cases of type C. Patients all received modified 270°spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column. The height of anterior edge of injured vertebral body, Cobb angle at the site of injury and the change of spinal canal compromise were compared before and after surgery. Bone fusion, spinal canal reconstruction, failure of instruments were evaluated. ASIA(2000) scoring standard was used to evaluate the functional recovery of spinal cord. Results: The operation time, intraoperative blood loss and volume of postoperative wound drainage were 120-180min(average 145±19.2min), 800-2200ml (average 1320±476.5ml) and 250-580ml(average 398±127.5ml) respectively. No wound infection, cerebrospinal fluid leakage, spinal nerve injury or neurological function deterioration was found after operation. All the patients were followed up for 12-36 months(average, 21.5±9.7 months) except one case who was lost of follow-up. All the patients obtained satisfactory bone fusion around the titanium mesh and received bone fusion at the surface of spinal canal with the good integrity of spinal canal. There were significant differences in the height of injured vertebral anterior edge, the Cobb angle of spine and spinal canal compromise between before and after surgery. But no significant difference in these indices was observed during the last follow-up compared to those immediately after surgery. There was no loosening, breakage of pedicle screws or displacement of titanium mesh. Dural calcification was found in one case. At the last follow-up, the neurological function of spinal cord did not change in one patient, as graded A according to ASIA scoring standard. Neurological function recovered to graded 1-2 in the other patients. Conclusions: The modified 270° spinal canal decompression with one-stage pedicle screw fixation and reconstruction of anterior and middle vertebral column can be the preferred method in treatment of severe thoracic and lumbar vertebral fractures with spinal canal compromise, it has the advantages of less trauma, perfect decompression, good stability, etc.