前路手術治療胸腰椎爆裂骨折伴截癱73例

[摘要] 目的 探討前路手術治療胸腰椎爆裂骨折伴截癱的價值。方法 對前路手術治療65例胸腰椎爆裂骨折伴截癱進行分析。結果 傷椎椎管侵占率、椎體壓縮率、后凸Cobb角術后初次及末次復查較術前有顯著性差異(P<0.05)，術后末次較初次復查無明顯變化(P>0.05);神經功能ASIA分級術后絕大部分有1~3級的提高;植骨全部融合;發生輕度脊柱側彎3例、后凸2例，內固定松動、鈦網內陷1例;肺部感染l例、下肢深靜脈血栓1例。結論 前路手術是治療胸腰椎爆裂骨折伴截癱的良好方法。

[關鍵詞] 胸腰椎;骨折;截癱;減壓;植骨融合;內固定

[中圖分類號] R683.2 [文獻標識碼] A [文章編號] 1673-9701(2010)04-68-03

Anterior Approach Surgery for Thoracolumbar Burst Fracture with Paraplegia:A Clinical Observation of 73 Cases

SUN JianzhongLI FuliangSUN Weirui

Department of Orthopedics，Luzhou People's Hospital，Luzhou 646000，China

[Abstract] Objective To investigate the application value of anterior approach surgery for thoracolumbar burst fracture with paraplegia. Methods A retrospective analysis was made of 65 cases of thoracolumbar burst fracture with paraplegia which underwent anterior surgery. Results The injured vertebral spinal canal encroachment rate，vertebral body compression ratio and kyphosis Cobb angle showed significant difference at the first review and last review after surgery compared with those before surgery(P<0.05). But showed no significant difference at the first review after surgery compared with those at the last review after surgery(P>0.05). According to the neurological function ASIA grading，the majority cases increased a 1~3 grade level after surgery，and all were cured with bone fusion in all bones，mild scoliosis in 3 cases，kyphosis in 2 cases，internal fixation loosening and titanium mesh invagination in one case，pulmonary infection in one case and deep venous thrombosis in one case. Conclusion The anterior approach surgery is a good therapy way for thoracolumbar burst fracture with paraplegia.

[Key words] Thoracolumbar;Fracture;Paraplegia;Decompression;Bone fusion;Internal fixation

胸腰椎爆裂骨折脊柱的穩定性遭到破壞，常伴脊髓和馬尾神經損傷引起的截癱，目前主張手術治療。2003年7月～2007年9月，對73例胸腰椎爆裂骨折伴截癱患者行前路手術治療，65例獲完整隨訪，取得滿意療效，報道如下。

1材料與方法

1.1病例資料

本組73例，65例獲完整隨訪，男43例，女22例，年齡18～65歲;車禍傷23例，墜落傷31例，壓砸傷11例;新鮮骨折48例，陳舊性骨折14例，后路手術后椎管狹窄伴神經癥狀者3例;T1111例，T1217例，L119例，L213例，T11-121例，T12-L12例，L1-22例。骨折按AO分類均為A3型。術前均進行X片、CT和或MRI檢查，椎體前緣壓縮>50%者51例，<50%但伴有脊髓神經損害表現者14例;椎管侵占率35.2%～81.4%;后凸Cobb角20～41°;入院時神經功能ASIA分級[1]:A級6例，B級19例，C級24例，D級16例;傷后3～21d手術48例，3～48周手術17例。

1.2手術方法

右側臥位，左側經胸或經胸膜腹膜外或經腹膜外入路，切除最高傷椎上兩個節段的一根肋骨，顯露傷椎及其上下椎體。依次結扎節段血管、安置上下椎體螺栓、切取所需長度的髂骨塊或鈦網備用、切除傷椎上下椎間盤、徹底清理上下椎體相對的軟骨終板、再切傷椎徹底減壓，以盡量縮短松質骨暴露時間，減少骨面及硬膜囊前方靜脈叢的出血。……