前后联合入路治疗严重腰椎爆裂性骨折

目的 探讨前后联合入路治疗严重腰椎爆裂性骨折的疗效.方法 回顾性分析2000年2月至2006年12月收治并获得随访的34例严重腰椎爆裂性骨折患者,男31例,女3例;年龄23～48岁,平均35.4岁.损伤部位:L_1 10例,L_2 14例,L_3 6例,L_4 4例;骨折按AO分型均为A3型;脊髓神经损伤按Frankel分级:A级4例,B级10例,C级14例,D级6例.术前椎体前缘高度丢失37%～71%,平均丢失46.6%±5.1%;后凸Cobb角5°～45°,平均25.5°±3.1°;腰椎管骨块侵入占椎管矢状径百分比为57%～98%,平均72.5%±3.1%.其中采用一期前后路手术19例,分期前后路手术15例. 结果 手术时间3.5～5.0 h,平均4.3 h;术中出血1400～2200 mL,平均1700 mL;输血1000～1600 mL,平均1280mL.术后椎体前缘高度恢复至正常的95%～100%,平均98.6%;后凸Cobb角-11°～9°,平均-2.0°±1.1°,与术前比较差异均有统计学意义(P<0.05).29例椎管得到彻底减压,无骨折块占位,其余5例椎管侧方仍有少量骨块.所有患者随访11～84个月,平均42.5个月.最后随访时伤椎前缘高度及后凸Cobb无明显丢失,与术后比较差异无统计学意义(P>0.05).无假关节形成,未出现内固定松动、断裂现象.脊髓神经功能除4例A级无变化外,其余均有Ⅰ～Ⅲ级的恢复,最后恢复到C级2例,D级15例,E级13例. 结论 前后联合入路是治疗严重腰椎爆裂性骨折的有效方法 ,但应严格把握手术适应证.

Severe burst fractures of lumbar vertebrae treated via combined anterior and posterior approaches

Objective To evaluate the efficacy of combined anterior and posterior approaches used for the treatment of severe burst fractures of lumbar vertebrae. Methods A retrospective review was conducted for the 34 patients with severe burst fracture of lumbar vertebrae who had been surgically managed from February 2000 to December 2006. They were 31 males and 3 females, with ages ranging from 23 to 48 years old (average, 35.4 years old) . L1 was involved in 10 cases, L2 in 14, L3 in 6, and L4 in 4 ones.According to AO classification, all patients were of A3 type. All patients underwent posterior reduction and transpodicle screw internal fixation combined with anterior decompression and bone graft. One-stage surgery was performed for 19 cases, and two-stage surgery for 15 cases. Neurological status and radiographs at pre-operative, postoperative and follow-up periods were reviewed. Results All the operations were successful without any neurological deterioration. The follow-up time for the 34 cases ranged from 11 to 84 months (mean, 42.5 months) . The spinal canal was enlarged, and the lumbar spine recovered to its normal curve.No evident correction loss was observed. All the patients obtained bony fusion. No hardware failure was found.The 4 patients with complete paralysis obtained no improvement in neural function, the other 30 patients with incomplete paralysis obtained improvement in Frankel Grades. Conclusion The combined anterior and posterior approaches may be an effective surgical treatment for severe burst fractures of lumbar vertebras,provided that the operative indications are strictly observed.