经椎弓根硬膜前方减压治疗胸腰椎爆裂性骨折

目的探讨一种治疗胸腰椎爆裂性骨折的有效方法。方法2004年5月~2006年1月,行经椎弓根硬膜前方减压植骨治疗20例胸腰椎爆裂性骨折。其中,男13例、女7例;年龄为30~65岁,平均42.3岁。按照AO脊柱骨折分类:A318例、B21例、C21例。Frankel分级:A级4例、B级6例、C级5例、D级3例、E级2例。均行半椎板切除,经椎弓根硬膜前方减压植骨,辅以未减压侧后外侧植骨,全部加用椎弓根钉内固定。对后凸畸形的矫正、病椎压缩程度的恢复、脊髓神经功能的康复进行评估,观察融合情况。结果20例患者均获得随访,随访时间为6~15个月,平均8.3月。Frankel分级:A级2例、B级4例、C级5例、D级5例、E级4例。术后摄片示椎管减压充分,后凸畸形完全纠正。3个月后植骨明显融合,术后6月Cobb角丢失4°~9°,平均7.3°。结论在严格的掌握适应症的前提下,经椎弓根硬膜前方减压是一种安全有效的胸腰椎爆裂性骨折治疗方法。

Decompression before dura mater through pedicle to treat thoracic or lumbar burst fractures

Objective To discuss an effective treatment for thoracic or lumbar burst fractures. Methods A retrospective study was made in 20 cases of thoracic or lumbar burst fractures from May, 2004 to January,2006. Eighteen cases were type A3, 1 case type B2, and 1 case type C₂, according to AO/ASIF fracture classification. Neurological status was Frankel grade A in 4 cases, B in 6 cases, C in 5 cases, D in 3 cases, E in 2 cases. There were 13 males and 7 females, with age range of 30-65 years(mean 42.3years). In all cases, the vertebral lamins of the hard compression side were resected. Decompression and bone grafting before dura mater through pedicle of vertebra were performed with additional posteroperative bone grafting and pedicle screw fixation systems. The kyphosis correction, cpmpression vertebra restoration, neurological recovery and bone grafting were analyzed. Results All cases were followed up for 6-15 months (average 8.3 months). Neurological status was improved to Frankel A in 2 cases, B in 4 cases, C in 5 cases, D in 5 cases, E in 4 cases. Two patients of Frankel A were unchanged. Complete decompression of spinal canal and correction of kyphosis were testified postoperatively by CT and X-ray. The fusion was observed between autograft and vertebrae and the correction loss of Cobb's angle averaged 7.3° (ranging from 4° to 9°) at 6 months after surgery. Conclusion With rigorous indication, decompression and bone grafting before dura mater through pedicle of vertebra is a safe and effective method to treat thoracic or lumbar burst fractures.