中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
1期
19-22
,共4页
于金河%孙先泽%任亮%侯树兵%顾振方
于金河%孫先澤%任亮%侯樹兵%顧振方
우금하%손선택%임량%후수병%고진방
脊髓损伤%爆裂骨折%骨折固定术,内
脊髓損傷%爆裂骨摺%骨摺固定術,內
척수손상%폭렬골절%골절고정술,내
Spinal cord injuries%Blow-out fractures%Fracture fixation,internal
目的 探讨后路椎管前后方同时减压、椎弓根钉棒系统治疗胸腰段爆裂骨折的方法与疗效.方法 对2006年2月至2009年11月采用后路椎管前后方同时减压、椎弓根钉棒系统治疗的28例伴有脊髓损伤的胸腰段骨折患者资料进行回顾性分析,男19例,女9例；年龄21～52岁,平均35.6岁.T11骨折3例,T12骨折11例,L1骨折9例,L2骨折5例.骨折按AO分型:A3型16例,B型7例,C型5例.按美国脊髓损伤委员会(ASIA)分级标准评定:A级6例,B级12例,C级10例. 结果 28例患者术后获12 ～ 24个月(平均14个月)随访,椎体前缘高度由术前46.8％±18.3％恢复至术后90.3％±14.2％,椎体后缘高度由术前80.4％±12.4％恢复至术后94.2％±15.1％,cobb角由术前平均20.1°±11.5°改善至2.7°±2.4°,以上项目手术前、后比较差异均有统计学意义(P＜0 05).按ASIA损伤分级评定神经恢复情况:6例A级损伤患者无明显变化,其余不完全损伤患者均有1～2级恢复. 结论 采用后路椎管前后方同时减压、椎弓根钉棒系统治疗有脊髓损伤的胸腰段爆裂骨折具有减压彻底、复位满意及内固定牢固等优点.
目的 探討後路椎管前後方同時減壓、椎弓根釘棒繫統治療胸腰段爆裂骨摺的方法與療效.方法 對2006年2月至2009年11月採用後路椎管前後方同時減壓、椎弓根釘棒繫統治療的28例伴有脊髓損傷的胸腰段骨摺患者資料進行迴顧性分析,男19例,女9例；年齡21～52歲,平均35.6歲.T11骨摺3例,T12骨摺11例,L1骨摺9例,L2骨摺5例.骨摺按AO分型:A3型16例,B型7例,C型5例.按美國脊髓損傷委員會(ASIA)分級標準評定:A級6例,B級12例,C級10例. 結果 28例患者術後穫12 ～ 24箇月(平均14箇月)隨訪,椎體前緣高度由術前46.8％±18.3％恢複至術後90.3％±14.2％,椎體後緣高度由術前80.4％±12.4％恢複至術後94.2％±15.1％,cobb角由術前平均20.1°±11.5°改善至2.7°±2.4°,以上項目手術前、後比較差異均有統計學意義(P＜0 05).按ASIA損傷分級評定神經恢複情況:6例A級損傷患者無明顯變化,其餘不完全損傷患者均有1～2級恢複. 結論 採用後路椎管前後方同時減壓、椎弓根釘棒繫統治療有脊髓損傷的胸腰段爆裂骨摺具有減壓徹底、複位滿意及內固定牢固等優點.
목적 탐토후로추관전후방동시감압、추궁근정봉계통치료흉요단폭렬골절적방법여료효.방법 대2006년2월지2009년11월채용후로추관전후방동시감압、추궁근정봉계통치료적28례반유척수손상적흉요단골절환자자료진행회고성분석,남19례,녀9례；년령21～52세,평균35.6세.T11골절3례,T12골절11례,L1골절9례,L2골절5례.골절안AO분형:A3형16례,B형7례,C형5례.안미국척수손상위원회(ASIA)분급표준평정:A급6례,B급12례,C급10례. 결과 28례환자술후획12 ～ 24개월(평균14개월)수방,추체전연고도유술전46.8％±18.3％회복지술후90.3％±14.2％,추체후연고도유술전80.4％±12.4％회복지술후94.2％±15.1％,cobb각유술전평균20.1°±11.5°개선지2.7°±2.4°,이상항목수술전、후비교차이균유통계학의의(P＜0 05).안ASIA손상분급평정신경회복정황:6례A급손상환자무명현변화,기여불완전손상환자균유1～2급회복. 결론 채용후로추관전후방동시감압、추궁근정봉계통치료유척수손상적흉요단폭렬골절구유감압철저、복위만의급내고정뢰고등우점.
Objective To discuss the operative efficacy of anterior- and postero-decompression plus pedicle screw instrumentation through posterior approach in the treatment of thoracolumbar burst fractures. Methods From February 2006 to November 2009,28 patients with thoracolumbar burst fracture and spinal cord injury were treated with anterior-and postero-decompression plus pedicle screw instrumenattion through posterior approach.They were 19 men and 9 women,21 to 52 years of age (average,35.6 years).The fractures happened at T11 in 3 cases,at T12 in 11 cases,at L1 in 9 cases and at L2 in 5 cases.By AO classification,there were 16 cases of type A3,7 cases of type B and 5 cases of type C.By the ASIA(American Spinal Injury Association) system,6 cases were rated as grade A,12 cases as grade B and 10 cases as grade C. Bone grafting was performed according to different conditions of the patients.Results The patients were followed for 12 months to 24 months,with an average of 14 months.The X-ray examinations showed that the mean anterior border height of the injured vertebrae recovered from 46.8％ ± 18.3％ of the normal height before operation to 90.3％ ± 14.2％ postoperatively; the mean posterior border height recovered from preoperative 80.4％ ± 12.4％ to postoperative 94.2％ ± 15.1％ ; and the mean cobb angle decreased from preoperative 20.1°± 11.5° to postoperative 2.7°± 2.4°. The differences between preoperation and postoperation were significant(P ＜ 0.05).According to the ASIA evaluation system,neurofunctional recovery was achieved in the cases of incomplete paralysis except in the 6 eases who had had complete spinal cord injury of Grade A. Conclusion Anterior- and posterro-decompression plus pedicle screw instrumentation through posterior approach is an effective method of treating thoracolumbar burst fractures.
