单侧椎弓根入路减压椎间融合治疗Denis B 型胸腰椎爆裂性骨折
收稿日期: 2014-07-30
网络出版日期: 2015-04-21
Posterior unilateral transpedicular decompression with interbody bone fusion and internal fixation for treatment of thoracolumbar burst fracture of Denis type B
Received date: 2014-07-30
Online published: 2015-04-21
目的 探讨经单侧椎弓根入路减压、椎体间植骨融合内固定术治疗Denis B 型胸腰椎爆裂性骨折的临床疗效。 方法 回顾性分析2008年4月~2011年1月采用经单侧椎弓根入路减压、椎体间植骨融合内固定术治疗12例 Denis B 型胸腰椎爆裂性骨折的患者，男8例，女4例;年龄20~55岁，平均35.5岁。通过比较术前、术后即刻及末次随访时的X线、CT片及神经学检查，观察骨折复位、植骨融合、神经功能恢复、矫正丢失、腰椎活动度及相邻节段椎间盘退变等情况来评估临床疗效。 结果 本组患者手术时间 150~200min，平均160 min。出血量 200~700 ml，平均450ml。术后随访时间12~36个月，平均21.5个月。所有患者伤椎均获得满意复位，术后随访3~6月时椎间植骨均达到骨性融合，随访中重建的椎体高度无丢失，神经功能获得1~2级恢复，平均提高1.5级。无内固定松动、断裂或者钛笼下沉等并发症，患者未出现顽固性腰痛，腰椎活动度好，邻近节段椎间盘未见明显退变征象。 结论 选择合适的患者，经单侧椎弓根入路减压、钛笼椎体间支撑植骨内固定术能有效的恢复脊柱生理曲度，能达到椎管充分减压和前中柱的支撑重建，同时保留伤椎相对正常的中下份椎体及下位未受损伤的椎间盘，降低融合术后相邻节段退变的风险。
杨东军 , 欧云生 , 涂平华 , 刘渤 , 朱勇 , 赵增辉 , 蒋电明 . 单侧椎弓根入路减压椎间融合治疗Denis B 型胸腰椎爆裂性骨折[J]. 中国临床解剖学杂志, 2015 , 33(2) : 218 -222 . DOI: 10.13418/j.issn.1001-165x.2015
Objective To explore the clinical outcomes of posterior unilateral transpedicular decompression with interbody bone fusion and internal fixation for treatment of thoracolumbar burst fracture of Denis type B. Methods A retrospective study was done on 12 patients with thoracolumbar burst fracture of Denis type B who were treated by this method from April 2008 to January 2011； There was 8 males and 4 females with an average age 35.5 years(rang, 20~55 years). Fracture reduction，graft fusion，neurological function recovery，correction loss，lumbar activities and adjacent segment degeneration were observed through preoperative，immediate postoperative and final following-up X-ray，CT and neurological examinations to evaluate the clinical efficacy. Results The surgical duration ranged from 150 to 200 minutes, averaging 160 minutes, and the bleeding volume ranged from 200 to 700 ml, averaging 450 ml. They were followed up for 12 to 36 months, averaging 21.5 months. The results showed the vertebral fusion time was 3~6 months, and no loss of vertebral height was observed. All patients had obtained improvement of neurological function by 1-2 ASIA grades. The complications such as disruption, breaking or loosening of the screwrods, collapse, refractory low back pain, limitation of motion and degeneration of adjacent intervertebral disc were not observed. Conclusions: As long as indication is correctly chosen, posterior unilateral transpedicular decompression with interbody bone fusion and internal fixation can effectively achieve restoration of the spine curvature, complete decompression of the spinal canal， strut fusion of the anterior column, and preservation of the inferior part of the fractured vertebral body and the intact disc under the injured vertebra. Reduction of the incidence of adjacent intervertebral disc degeneration can also result from this surgical approachThoracolumbar burst fracture; Spinal fusion; Ppedicle screw internal fixation
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