經后路椎管前方減壓三柱重建治療胸腰椎單節段不穩定骨折_《中國修復重建外科雜志》

作者：

劉佐忠 , 柯珍勇 , 陳亮 , 晏錚劍 , 陳富 , 鄧忠良

重慶醫科大學附屬第二醫院骨科（重慶，400010）;

關鍵詞：

不穩定胸腰椎骨折后側入路椎管減壓脊柱重建

DOI：

10.7507/1002-1892.20130181

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目的探討單純經后路椎管前方減壓、三柱重建治療胸腰椎單節段不穩定骨折的臨床療效。方法 2009年3月－2011年10月，收治胸腰椎單節段不穩定骨折39例。其中男32例，女7例；年齡25～68歲，平均43.8歲。致傷原因：高處墜落傷17例，砸傷10例，交通事故傷4例，其他8例。病變累及節段：T10 1例，T11 9例，T12 6例，L1 14例，L2 7例，L3 1例，L4 1例。術前Frankel分級：A級5例，B級5例，C級9例，D級14例，E級6例。傷椎后凸Cobb角（26.7 ± 7.1）°，椎體高度丟失37.5% ± 9.5%，椎管占位73.7% ± 11.3%。傷后至手術時間1～4 d，平均2.5 d。均采用經后路椎管前方減壓、鈦籠植入前中柱、后柱減壓融合、三柱重建治療。對手術前后椎體高度恢復情況、后凸畸形矯正程度、椎管減壓是否徹底、術后神經功能恢復狀況等進行評價。結果術后1例出現截癱平面上升、1例尿路感染、2例壓瘡；余患者均未出現切口感染、神經損傷癥狀加重或新的神經癥狀，患者切口均Ⅰ期愈合。39例均獲隨訪，隨訪時間12～36個月，平均27個月。患者術后無腰背部疼痛加重；無螺釘松動、斷釘、斷棒等并發癥發生；未出現鈦合金電解、鈦籠沉降斷裂。術后2年影像學檢查提示椎管減壓徹底，椎體高度恢復滿意，生理曲度維持良好。末次隨訪時Frankel分級為A級1例，B級2例，C級2例，D級10例，E級24例，較術前顯著改善（P lt; 0.05）。術后即刻與末次隨訪時后凸Cobb角分別為（6.3 ± 2.1）°和（6.5 ± 2.4）°，傷椎高度丟失分別為7.9% ± 2.7%和8.2% ± 3.0%，均較術前顯著改善（P lt; 0.05）。結論經后路椎管前方減壓、三柱重建治療胸腰椎單節段不穩定骨折，能徹底減壓、三柱重建、即刻恢復脊柱穩定性，是一種理想的手術方式。

引用本文： 劉佐忠,柯珍勇,陳亮,晏錚劍,陳富,鄧忠良. 經后路椎管前方減壓三柱重建治療胸腰椎單節段不穩定骨折. 中國修復重建外科雜志, 2013, 27(7): 824-828. doi: 10.7507/1002-1892.20130181 復制

1.	Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine (Phila Pa 1976), 2006, 31(8): 859-868.
2.	Tezer M, Ertuer RE, Ozturk C, et al. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop, 2005, 29(2): 78-82.
3.	McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4.	Benson DR, Burkus JK, Montesano PX, et al. Unstable Thoracolumbar and lumbar burst fractures treated with the AO fixateur inerne. J Spinal Disord, 1992, 5(3): 335-343.
5.	Willen J, Anderson J, Toomoka K, et al. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord, 1990, 3(1): 39-46.
6.	Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of thoracolumbar junction. J Trauma, 1988, 28(8): 1188-1194.
7.	Mcdonough PW, Davis R, Tribus C, et al. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976), 2004, 29(17): 1901-1909.
8.	徐兆萬, 隋國俠, 王炳武, 等. 有限減壓相鄰節段植骨內固定術治療胸腰椎骨折. 中國矯形外科雜志, 2007, 15(2): 91-93.
9.	Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
10.	袁文. 脊柱脊髓損傷診治的歷史、現狀與展望. 中華創傷雜志, 2007, 23(9): 641-642.
11.	馬維虎, 徐榮明, 馮建翔, 等. 經椎弓根植骨和椎體成形術治療胸腰椎爆裂性骨折. 骨與關節損傷雜志, 2003, 18(8): 511-513.
12.	Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
13.	Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumbar and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
14.	侯力強, 李建軍, 汪力平, 等. 后路椎管三方減壓病椎植骨重建治療胸腰椎爆裂性骨折. 浙江創傷外科雜志, 2010, 15(6): 782-783.
15.	Tomita K, Kawahara N, Murakami H, et al. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci, 2006, 11(1): 3-12.
16.	Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1): 8-14.
17.	Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1): E33-40.
18.	Haiyun Y, Rui G, Shucai D, et al. Three-column reconstruction through single posterior approach for treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976), 2010, 35(8): E295-302.
19.	Young W, Flamm ES. Effect of high-dose corticosteroid therapy on blood flow, evoked potentials, and extracellular calcium in experimental spinal injury. J Neurosurg, 1982, 57(5): 667-673.
20.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
21.	Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa1976), 2004, 29(7): 803-814.

1. Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine (Phila Pa 1976), 2006, 31(8): 859-868.
2. Tezer M, Ertuer RE, Ozturk C, et al. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop, 2005, 29(2): 78-82.
3. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4. Benson DR, Burkus JK, Montesano PX, et al. Unstable Thoracolumbar and lumbar burst fractures treated with the AO fixateur inerne. J Spinal Disord, 1992, 5(3): 335-343.
5. Willen J, Anderson J, Toomoka K, et al. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord, 1990, 3(1): 39-46.
6. Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of thoracolumbar junction. J Trauma, 1988, 28(8): 1188-1194.
7. Mcdonough PW, Davis R, Tribus C, et al. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976), 2004, 29(17): 1901-1909.
8. 徐兆萬, 隋國俠, 王炳武, 等. 有限減壓相鄰節段植骨內固定術治療胸腰椎骨折. 中國矯形外科雜志, 2007, 15(2): 91-93.
9. Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
10. 袁文. 脊柱脊髓損傷診治的歷史、現狀與展望. 中華創傷雜志, 2007, 23(9): 641-642.
11. 馬維虎, 徐榮明, 馮建翔, 等. 經椎弓根植骨和椎體成形術治療胸腰椎爆裂性骨折. 骨與關節損傷雜志, 2003, 18(8): 511-513.
12. Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
13. Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumbar and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
14. 侯力強, 李建軍, 汪力平, 等. 后路椎管三方減壓病椎植骨重建治療胸腰椎爆裂性骨折. 浙江創傷外科雜志, 2010, 15(6): 782-783.
15. Tomita K, Kawahara N, Murakami H, et al. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci, 2006, 11(1): 3-12.
16. Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1): 8-14.
17. Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1): E33-40.
18. Haiyun Y, Rui G, Shucai D, et al. Three-column reconstruction through single posterior approach for treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976), 2010, 35(8): E295-302.
19. Young W, Flamm ES. Effect of high-dose corticosteroid therapy on blood flow, evoked potentials, and extracellular calcium in experimental spinal injury. J Neurosurg, 1982, 57(5): 667-673.
20. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
21. Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa1976), 2004, 29(7): 803-814.

《中國修復重建外科雜志》

經后路椎管前方減壓三柱重建治療胸腰椎單節段不穩定骨折

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《中國修復重建外科雜志》

經后路椎管前方減壓三柱重建治療胸腰椎單節段不穩定骨折

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