经后路单侧开窗270°减压治疗伴神经损伤型胸腰椎爆裂性骨折的临床疗效分析
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摘要
目的:探讨经后路肌间隙入路单侧开窗椎管270°减压治疗伴神经损伤型胸腰椎爆裂性骨折的临床疗效。方法:回顾性分析28例伴神经损伤型胸腰椎爆裂性骨折患者的临床资料,本组患者均接受经肌间隙入路单侧开窗椎管270°减压治疗,比较手术治疗前以及手术治疗后3 d的伤椎高度、伤椎矢状位Cobb角、椎管内骨块占位率,并对患者的预后情况进行总结。结果:本组患者术后3 d的伤椎高度高于术前,伤椎矢状位Cobb角和椎管内骨块占位率低于术前,差异均有统计学意义(P <0. 05);通过6～18个月的随访,无死亡和神经症状加重患者,1例患者发生脑脊液漏,对症处理后得以痊愈,1例患者手术后3个月出现椎弓根螺钉松动,半年后予以拆除。结论:经后路肌间隙入路单侧开窗椎管270°减压可有效治疗伴神经损伤型胸腰椎爆裂性骨折,术后可使脊柱结构以及稳定性得到有效保留,同时可使椎管得到有效减压。
Objective: To evaluate the clinical efficacy of 270-degree decompression of unilateral open window canal in the treatment of thoracolumbar burst fractures with posterior approach. Methods: The clinical data of 28 patients with thoracolumbar burst fractures with nerve injury were retrospectively analyzed. All patients underwent 270-degree decompression of unilateral fenestration through the intermuscular approach,compared with 3 days after surgery and 3 days after surgery. The height of the injured vertebrae,the sagittal Cobb angle of the injured vertebrae,the bone occupying rate of the spinal canal,and the prognosis of the patients were summarized. Results: The height of the injured vertebrae in this group was higher than that before operation. The Cobb angle of the sagittal plane and the bone occupying rate of the spinal canal were lower than those before operation,and the difference was statistically significant(P < 0. 05). At the follow-up of 6-18 months,there were no death and neurological symptoms in this group. One patient developed cerebrospinal fluid leakage and recovered after symptomatic treatment. One patient developed pedicle screw loosening 3 months after surgery and was removed after half a year. Conclusions: The 270-degree decompression of the unilateral open window canal can effectively treat the thoracolumbar burst fracture with nerve injury through the posterior approach. The postoperative structure and stability of the spine can be effectively preserved,and the spinal canal can be effectively effective stress reliever.
Objective: To evaluate the clinical efficacy of 270-degree decompression of unilateral open window canal in the treatment of thoracolumbar burst fractures with posterior approach. Methods: The clinical data of 28 patients with thoracolumbar burst fractures with nerve injury were retrospectively analyzed. All patients underwent 270-degree decompression of unilateral fenestration through the intermuscular approach,compared with 3 days after surgery and 3 days after surgery. The height of the injured vertebrae,the sagittal Cobb angle of the injured vertebrae,the bone occupying rate of the spinal canal,and the prognosis of the patients were summarized. Results: The height of the injured vertebrae in this group was higher than that before operation. The Cobb angle of the sagittal plane and the bone occupying rate of the spinal canal were lower than those before operation,and the difference was statistically significant(P < 0. 05). At the follow-up of 6-18 months,there were no death and neurological symptoms in this group. One patient developed cerebrospinal fluid leakage and recovered after symptomatic treatment. One patient developed pedicle screw loosening 3 months after surgery and was removed after half a year. Conclusions: The 270-degree decompression of the unilateral open window canal can effectively treat the thoracolumbar burst fracture with nerve injury through the posterior approach. The postoperative structure and stability of the spine can be effectively preserved,and the spinal canal can be effectively effective stress reliever.
引文
[1]张健.前后路手术治疗胸腰椎爆裂性骨折的效果及特点分析[J].颈腰痛杂志,2017,38(6):525-528.
[2]周喜宗,汪厚军,郭伦强,等.后路椎管270°环形减压伤椎置钉内固定治疗胸腰椎爆裂性骨折[J].中华骨与关节外科杂志,2018,11(5):330-333.
[3]温广宇,杨益,梁尊鸿,等.经皮椎体后凸成形术在老年骨质疏松性胸腰椎爆裂性骨折中的临床疗效[J].湖南师范大学学报(医学版),2018,15(4):80-82.
[4]颜嵩,张学恒,杨建新,等.不同入路治疗胸腰椎爆裂性骨折合并脊髓神经损伤的疗效分析[J].江西医药,2016,51(5):428-430.
[5]廖国平,邓芳文,孙德贵,等.前入路与后入路手术比较治疗胸腰椎爆裂性骨折的Meta分析[J].临床医药实践,2015,24(10):725-731.
[6]李杰.经伤椎单侧椎弓根减压后路复位固定及植骨治疗胸腰椎爆裂性骨折的效果[J].中国医药导报,2016,13(15):104-107.
[7]王兴盛,王想福.经伤椎固定联合有限开窗减压治疗胸腰椎爆裂性骨折[J].中国微创外科杂志,2014,14(8):719-722.
[8]朱海明,丁亮,张东,等.胸腰椎爆裂性骨折短节段伤椎固定三维有限元模型构建及生物力学比较研究[J].中国矫形外科杂志,2015,23(10):917-920.
[2]周喜宗,汪厚军,郭伦强,等.后路椎管270°环形减压伤椎置钉内固定治疗胸腰椎爆裂性骨折[J].中华骨与关节外科杂志,2018,11(5):330-333.
[3]温广宇,杨益,梁尊鸿,等.经皮椎体后凸成形术在老年骨质疏松性胸腰椎爆裂性骨折中的临床疗效[J].湖南师范大学学报(医学版),2018,15(4):80-82.
[4]颜嵩,张学恒,杨建新,等.不同入路治疗胸腰椎爆裂性骨折合并脊髓神经损伤的疗效分析[J].江西医药,2016,51(5):428-430.
[5]廖国平,邓芳文,孙德贵,等.前入路与后入路手术比较治疗胸腰椎爆裂性骨折的Meta分析[J].临床医药实践,2015,24(10):725-731.
[6]李杰.经伤椎单侧椎弓根减压后路复位固定及植骨治疗胸腰椎爆裂性骨折的效果[J].中国医药导报,2016,13(15):104-107.
[7]王兴盛,王想福.经伤椎固定联合有限开窗减压治疗胸腰椎爆裂性骨折[J].中国微创外科杂志,2014,14(8):719-722.
[8]朱海明,丁亮,张东,等.胸腰椎爆裂性骨折短节段伤椎固定三维有限元模型构建及生物力学比较研究[J].中国矫形外科杂志,2015,23(10):917-920.
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