胸腰段脊柱骨折的治疗进展
|
摘要
胸腰段脊柱骨折因其致伤暴力强大、发生机制复杂、为脊柱带来的破坏性大(甚至可破坏椎体三柱结构),严重影响脊柱的稳定性,患者常伴脊髓神经损伤,致残率高。目前对于部分病情较轻的胸腰段脊柱骨折患者可先开展非手术治疗,但多数患者非手术治疗效果不佳,故手术治疗成为主要的胸腰段脊柱骨折治疗方法。现常用的胸腰段脊柱骨折治疗术式多样,包括前路、后路、前路联合后路及微创术式,各术式均有其优缺点,为保证手术实施的有效性与安全性,常需要根据患者具体情况进行选择。
Thoracolumbar spine fracture is severe due to its violent trauma,complex mechanism and destructiveness to the spine( even destroying the three-column structure of the vertebral body),which seriously affects the stability of the spine. The patients often have spinal nerve trauma,resulting in high disability rate. At present,some patients with mild thoracolumbar spine fracture can be treated with non-surgical therapy at first,but most patients have poor results from nonsurgical therapy,so surgical therapy has become the main treatment method. The commonly used treatment methods are various,including anterior approach,posterior approach,anterior combined posterior approach and minimally invasive procedures. Each procedure has its advantages and disadvantages,in order to ensure the effectiveness and safety of the operation,it is necessary to make a choice according to the patients' specific conditions.
Thoracolumbar spine fracture is severe due to its violent trauma,complex mechanism and destructiveness to the spine( even destroying the three-column structure of the vertebral body),which seriously affects the stability of the spine. The patients often have spinal nerve trauma,resulting in high disability rate. At present,some patients with mild thoracolumbar spine fracture can be treated with non-surgical therapy at first,but most patients have poor results from nonsurgical therapy,so surgical therapy has become the main treatment method. The commonly used treatment methods are various,including anterior approach,posterior approach,anterior combined posterior approach and minimally invasive procedures. Each procedure has its advantages and disadvantages,in order to ensure the effectiveness and safety of the operation,it is necessary to make a choice according to the patients' specific conditions.
引文
[1] Weerink LBM,Folbert EC,Kraai M,et al. Thoracolumbar spine fractures in the geriatric fracturecenter:Early ambulation leads to good results on short term and is a successful and safe alternative compared to immobilization in elderly patients with two-column vertebral fractures[J]. Geriatr Orthop Surg Rehabil,2014,5(2):43-49.
[2] Medici A,Meccariello L,Falzarano G. Non-operative vs. percutaneous stabilization in Magerl's A1 or A2 thoracolumbar spine fracture in adults:Is it really advantageous for a good alignment of the spine Preliminary data from a prospective study[J]. Eur Spine J,2014,23 Suppl 6:677-683.
[3] Vaccaro AR,Oner C,Kepler CK,et al. AOSpine thoracolumbar spine injury classification system:Fracture description,neurological status,and key modifiers[J]. Spine(Phila Pa 1976),2013,38(23):2028-2037.
[4]谢朝云,闫飞,熊永发,等.胸腰段脊柱骨折患者医院感染影响因素分析[J].中国矫形外科杂志,2017,25(10):888-892.
[5]范顺武,胡志军.胸腰段脊柱骨折微创治疗入路选择探讨[J].中华创伤杂志,2017,33(6):481-484.
[6] Lewkonia P,Paolucci EO,Thomas K. Reliability of the thoraco.lumbar injury classification and severity score and comparison to the denis classification for injury to the thoracic and lumbar spine[J].Spine(Phila Pa 1976),2012,37(26):2161-2167.
[7]伍骥,黄蓉蓉.重视胸腰段脊柱骨折的诊断和治疗[J].中国骨伤,2015,28(1):1-3.
[8]陈晓亮.脊柱外科实用图谱[M].北京:人民卫生出版社,2003:46-47.
[9] Wood KB,Li WS,Lebl DR,et al. Management of thoracolumbar spine fractures[J]. Spine J,2014,14(1):145-164.
[10] Gandhoke GS,Tempel ZJ,Bonfield CM,et al. Technical nuances of the minimally invasive extreme lateral approach to treat thoracolumbar burst fractures[J]. Eur Spine J,2015,24(Suppl 3):353-360.
[11]钱宇,何磊.正确认识胸腰段脊柱骨折分型[J].中华创伤杂志,2017,33(6):488-490.
[12] Lopez AJ,Scheer JK,Smith ZA,et al. Management of flexion distraction injuries to thethoracolumbar spine[J]. J Clin Neurosci,2015,22(12):1853-1856.
[13] Mahajan R,Chhabra HS. Re:Two-year follow-up evaluation of surgical treatment forthoracolumbar fracture dislocation[J]. Spine(Phila Pa 1976),2015,40(4):273.
[14]吴爱悯.胸腰段脊柱骨折定量影像学[J].临床与病理杂志,2017,37(4):649-660.
[15]伍骥,郑超,黄蓉蓉.重新认识胸腰段脊柱骨折的诊断和治疗[J].中国骨与关节杂志,2016,5(6):401-404.
[16]魏劲松.前路与后路内固定治疗成人胸腰段脊柱骨折临床分析[J].中国医药导报,2013,10(22):49-51.
[17] Zhang F,Chen XQ,Chen XD,et al. Surgery for severe thoracolumbar fracture via a posterior approach[J]. J Clin Neurosci,2015,22(12):1954-1958.
[18]张纯,姚聪,贺西京,等.胸腰段脊柱骨折不同节段固定对手术疗效的影响[J].中国骨与关节损伤杂志,2013,28(3):207-209.
[19]刘刚,梁裕.前后路手术治疗胸腰段脊柱骨折的临床疗效分析[J].昆明医科大学学报,2015,36(10):75-79.
[20] Crostelli M,Mazza O,Mariani M. Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age:Results with 3 years mean follow up[J]. Eur Spine J,2014,23(1):209-215.
[21] Wu H,Fu C,Yu WD,et al. The options of the three different surgical approaches for the treatment of Denis type A and B thoracolumbar burst fracture[J]. Eur J Orthop Surg Traumatol,2014,24(1):29-35.
[22]马毅,邓树才,贾占华,等.比较胸腰段爆裂骨折前后路联合和后路伤椎次全切内固定植骨融合的中长期疗效[J].中华医学杂志,2013,93(27):2112-2116.
[23] Li H,Yang L,Xie H,et al. Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with singlesegment thoracolumbar fractures without neurologic injury[J]. J Biomed Res,2015,29(1):76-82.
[24]孔祥清,孟纯阳,张卫红,等.微创经皮穿刺椎弓根内固定术治疗胸腰椎骨折的临床疗效观察[J].中国矫形外科杂志,2015,23(8):692-695.
[25]吴昊.微创经皮穿刺椎弓根内固定术治疗胸腰椎骨折的临床疗效观察[J].河北医学,2016,22(6):936-939.
[26] Charles YP,Walter A,Schuller S,et al. Temporary percutaneous instrumentation and selective anterior fusion for thoracolumbar fractures[J]. Spine(Phila Pa 1976),2017,42(9):E523.
[27] Cui S,Busel GA,Puryear AS. Temporary percutaneous pedicle screw stabilization without fusion of adolescent thoracolumbar spine fractures[J]. J Pediatr Orthop,2016,36(7):701.
[28]唐飞,张荣,彭兴平,等.伤椎置钉单节段固定与短节段固定治疗胸腰段脊柱骨折分析[J].创伤外科杂志,2015,17(4):358,368.
[29] Park SR,Na HY,Kim JM,et al. More than 5-year follow-up results of two-level and three-level posterior fixations of thoracolumbar burst fractures with load-sharing scores of seven and eight points[J]. Clin Orthop Surg,2016,8(1):71-77.
[30] PelliséF,Barastegui D,Hernandezfernandez A,et al. Viability and long-term survival of short-segment posterior fixation in thoracolumbar burst fractures[J]. Spine J,2015,15(8):1796-1803.
[2] Medici A,Meccariello L,Falzarano G. Non-operative vs. percutaneous stabilization in Magerl's A1 or A2 thoracolumbar spine fracture in adults:Is it really advantageous for a good alignment of the spine Preliminary data from a prospective study[J]. Eur Spine J,2014,23 Suppl 6:677-683.
[3] Vaccaro AR,Oner C,Kepler CK,et al. AOSpine thoracolumbar spine injury classification system:Fracture description,neurological status,and key modifiers[J]. Spine(Phila Pa 1976),2013,38(23):2028-2037.
[4]谢朝云,闫飞,熊永发,等.胸腰段脊柱骨折患者医院感染影响因素分析[J].中国矫形外科杂志,2017,25(10):888-892.
[5]范顺武,胡志军.胸腰段脊柱骨折微创治疗入路选择探讨[J].中华创伤杂志,2017,33(6):481-484.
[6] Lewkonia P,Paolucci EO,Thomas K. Reliability of the thoraco.lumbar injury classification and severity score and comparison to the denis classification for injury to the thoracic and lumbar spine[J].Spine(Phila Pa 1976),2012,37(26):2161-2167.
[7]伍骥,黄蓉蓉.重视胸腰段脊柱骨折的诊断和治疗[J].中国骨伤,2015,28(1):1-3.
[8]陈晓亮.脊柱外科实用图谱[M].北京:人民卫生出版社,2003:46-47.
[9] Wood KB,Li WS,Lebl DR,et al. Management of thoracolumbar spine fractures[J]. Spine J,2014,14(1):145-164.
[10] Gandhoke GS,Tempel ZJ,Bonfield CM,et al. Technical nuances of the minimally invasive extreme lateral approach to treat thoracolumbar burst fractures[J]. Eur Spine J,2015,24(Suppl 3):353-360.
[11]钱宇,何磊.正确认识胸腰段脊柱骨折分型[J].中华创伤杂志,2017,33(6):488-490.
[12] Lopez AJ,Scheer JK,Smith ZA,et al. Management of flexion distraction injuries to thethoracolumbar spine[J]. J Clin Neurosci,2015,22(12):1853-1856.
[13] Mahajan R,Chhabra HS. Re:Two-year follow-up evaluation of surgical treatment forthoracolumbar fracture dislocation[J]. Spine(Phila Pa 1976),2015,40(4):273.
[14]吴爱悯.胸腰段脊柱骨折定量影像学[J].临床与病理杂志,2017,37(4):649-660.
[15]伍骥,郑超,黄蓉蓉.重新认识胸腰段脊柱骨折的诊断和治疗[J].中国骨与关节杂志,2016,5(6):401-404.
[16]魏劲松.前路与后路内固定治疗成人胸腰段脊柱骨折临床分析[J].中国医药导报,2013,10(22):49-51.
[17] Zhang F,Chen XQ,Chen XD,et al. Surgery for severe thoracolumbar fracture via a posterior approach[J]. J Clin Neurosci,2015,22(12):1954-1958.
[18]张纯,姚聪,贺西京,等.胸腰段脊柱骨折不同节段固定对手术疗效的影响[J].中国骨与关节损伤杂志,2013,28(3):207-209.
[19]刘刚,梁裕.前后路手术治疗胸腰段脊柱骨折的临床疗效分析[J].昆明医科大学学报,2015,36(10):75-79.
[20] Crostelli M,Mazza O,Mariani M. Posterior approach lumbar and thoracolumbar hemivertebra resection in congenital scoliosis in children under 10 years of age:Results with 3 years mean follow up[J]. Eur Spine J,2014,23(1):209-215.
[21] Wu H,Fu C,Yu WD,et al. The options of the three different surgical approaches for the treatment of Denis type A and B thoracolumbar burst fracture[J]. Eur J Orthop Surg Traumatol,2014,24(1):29-35.
[22]马毅,邓树才,贾占华,等.比较胸腰段爆裂骨折前后路联合和后路伤椎次全切内固定植骨融合的中长期疗效[J].中华医学杂志,2013,93(27):2112-2116.
[23] Li H,Yang L,Xie H,et al. Surgical outcomes of mini-open Wiltse approach and conventional open approach in patients with singlesegment thoracolumbar fractures without neurologic injury[J]. J Biomed Res,2015,29(1):76-82.
[24]孔祥清,孟纯阳,张卫红,等.微创经皮穿刺椎弓根内固定术治疗胸腰椎骨折的临床疗效观察[J].中国矫形外科杂志,2015,23(8):692-695.
[25]吴昊.微创经皮穿刺椎弓根内固定术治疗胸腰椎骨折的临床疗效观察[J].河北医学,2016,22(6):936-939.
[26] Charles YP,Walter A,Schuller S,et al. Temporary percutaneous instrumentation and selective anterior fusion for thoracolumbar fractures[J]. Spine(Phila Pa 1976),2017,42(9):E523.
[27] Cui S,Busel GA,Puryear AS. Temporary percutaneous pedicle screw stabilization without fusion of adolescent thoracolumbar spine fractures[J]. J Pediatr Orthop,2016,36(7):701.
[28]唐飞,张荣,彭兴平,等.伤椎置钉单节段固定与短节段固定治疗胸腰段脊柱骨折分析[J].创伤外科杂志,2015,17(4):358,368.
[29] Park SR,Na HY,Kim JM,et al. More than 5-year follow-up results of two-level and three-level posterior fixations of thoracolumbar burst fractures with load-sharing scores of seven and eight points[J]. Clin Orthop Surg,2016,8(1):71-77.
[30] PelliséF,Barastegui D,Hernandezfernandez A,et al. Viability and long-term survival of short-segment posterior fixation in thoracolumbar burst fractures[J]. Spine J,2015,15(8):1796-1803.