经后路椎体次全切除三柱重建治疗不稳定性胸、腰椎单发爆裂骨折的临床研究

目的探讨经后路椎体次全切除三柱重建治疗不稳定性胸、腰椎单发爆裂骨折的临床疗效。方法选取本院2009年2月~2011年2月收治的不稳定性胸、腰椎单发爆裂骨折患者26例,均采用后路椎体次全切除三柱重建术治疗,比较患者治疗前后的各项临床指标。结果患者均顺利完成手术,手术时间为(192.4±30.7)min,术中出血量为(685.1±219.3)mL,术后24 h的伤口引流量为(327.4±48.1)mL,骨折愈合时间为(17.9±3.2)周。术后患者发生脊柱曲度异常改变1例,感染2例,术后并发症的发生率为11.5%。患者术后的伤椎前缘高度、伤椎后缘高度、椎管容积率均明显大于术前,Cobb角明显小于术前,差异均有统计学意义(P<0.05)。患者术后的Frankel分级评定情况明显好于术前(P<0.05)。结论经后路椎体次全切除三柱重建治疗不稳定性胸、腰椎单发爆裂骨折具有显著的临床疗效,可以明显改善患者的临床指标,恢复脊柱生理曲度并重建脊柱稳定性,是一种安全有效的手术方法,值得临床推广使用。

Clinical research of posterior corpectomy three column reconstruction in the treatment of unstable thoracic,lumbar single burst fracture

Objective To investigate the clinical efficacy of posterior corpectomy three column reconstruction in the treatment of unstable thoracic,lumbar single burst fracture.Methods 26 cases of patients with unstable thoracic,lumbar single burst fracture in our hospital from February 2009 to February 2011 were selected.All patients were treated with posterior corpectomy three column reconstruction.Clinical indexes were compared before and after treatment.Results All patients were successfully completed operation.Operation time was（192.4±30.7） min;the amount of bleeding in operation was（685.1±219.3） mL;amount of 24 h postoperative wound drainage was（327.4±48.1） mL;fracture healing time was（17.9±3.2） weeks.After operation 1 case of patient suffered with postoperative spinal curvature changes,while 2 cases with infection,the postoperative complication rate was 11.5%.Vertebral height of the front edge,vertebral height of the back edge,spinal canal volume rate of patients after operation were significantly higher than those of before operation,while Cobb angle of patients after operation was smaller than that of before operation,the differences were statistically significant（P 0.05）.Frankel grading of patients after operation was obviously better than that before operation（P 0.05）.Conclusion Posterior corpectomy three column reconstruction in the treatment of unstable thoracic,lumbar single burst fracture has obvious clinical curative effect,which can significantly improve the clinical indicators of patients,restore spinal physiological curvature and reconstruct spinal stability.It is a safe and effective operation method,which is worthy of clinical use.