后路切开复位椎弓根螺钉固定并自体椎板状髂骨块植骨融合治疗胸腰段椎体爆裂性骨折的疗效
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摘要
背景:胸腰段椎体骨折是脊柱骨折中发生率最高的,对于胸腰段椎体严重爆裂性骨折合并神经功能损伤的患者,手术减压并重建脊柱稳定性治疗为重要的干预方式,但术后稳定性重建方式尚存争议。目的:探讨后路切开复位椎弓根螺钉固定并自体椎板状髂骨块植骨融合治疗胸腰段椎体爆裂性骨折伴神经功能损伤患者的疗效。方法:回顾性分析2012年1月至2016年12月间43例胸腰段单椎体爆裂性骨折伴神经功能损伤并行取髂骨重建椎板手术治疗的患者的临床资料,比较手术前后患者胸腰椎疼痛视觉模拟评分(VAS)、椎管占位率、伤椎椎体前缘高度与正常高度的比值、Cobb角及神经功能美国脊柱损伤协会(ASIA)分级。结果:所有患者均成功完成手术。术后随访所有患者植骨均获得融合,无一例患者出现断钉、断棒。术后1、12个月患者胸腰椎疼痛VAS评分均低于术前,伤椎椎体前缘高度与正常高度的比值均高于术前,Cobb角均小于术前,且差异均有统计学意义(P均<0.001);而术后1个月与术后12个月患者胸腰椎疼痛VAS评分、伤椎椎体前缘高度与正常高度的比值、Cobb角差异均无统计学意义。术后6个月患者椎管占位率小于术前,且差异有统计学意义(t=20.066,P<0.05)。术后12个月与术前患者神经功能ASIA分级差异有统计学意义(Z=-5.372,P<0.001)。术后12个月患者神经功能明显改善。结论:取髂骨重建椎板可减少术后椎体高度丢失及再发后凸畸形,避免继发性椎管狭窄压迫脊髓导致神经功能损害,是一种治疗胸腰段椎体爆裂性骨折的有效方法。
Background:Thoracolumbar vertebral fractures have the highest incidence in spine injuries.For patients with severe thoracolumbar burst fractures combined with neurological dysfunction,surgical decompression and reconstruction of spinal stability are important interventions.However,the method of postoperative stability reconstruction is still controversial.Objective:To evaluate the clinical effect of posterior decompression,pedicle screw fixation,and interlaminar iliac bone autograft fusion for patients with thoracolumbar burst fractures and neurological deficits.Methods:Clinical data of 43 patients with single vertebral thoracolumbar burst fracture combined with neurological deficits treated by interlaminar iliac bone autograft fusion with laminectomy from January 2012 to December 2016 were retrospectively analyzed.Visual analog scale(VAS)score of thoracolumbar pain,the ratio of spinal canal occupancy,height ratio of anterior border to vertebral body,Cobb angle and the nerve function of the American Spinal Injury Association(ASIA)Rating were recorded and compared before and after surgery.Results:All patients underwent the surgery successfully and bone grafts were fused during follow up.No broken nails or broken rods occurred.The VAS scores and Cobb angle at 1 and 12 months after operation were significantly lower than preoperative ones(P<0.001).The height ratio of anterior border to the vertebral body at 1 and 12 months after operation was higher than preoperative one(P<0.001).But there was no significant difference in these parameters between 1 month and 12 months postoperatively.The rate of spinal canal occupancy at 6 months after operation was significantly lower than preoperative(t=20.066,P<0.05).There was a statistical difference in the neurological function of ASIA between 12 months postoperatively and preoperatively(Z=-5.372,P<0.001).The neurological function was significantly improved at 12 months after surgery.Conclusions:Reconstruction of the lamina can reduce the loss of the vertebral body height and the incidence of kyphosis,and avoid the neurological damage caused by the spinal canal stenosis.It is an effective method for thoracolumbar burst fractures.
Background:Thoracolumbar vertebral fractures have the highest incidence in spine injuries.For patients with severe thoracolumbar burst fractures combined with neurological dysfunction,surgical decompression and reconstruction of spinal stability are important interventions.However,the method of postoperative stability reconstruction is still controversial.Objective:To evaluate the clinical effect of posterior decompression,pedicle screw fixation,and interlaminar iliac bone autograft fusion for patients with thoracolumbar burst fractures and neurological deficits.Methods:Clinical data of 43 patients with single vertebral thoracolumbar burst fracture combined with neurological deficits treated by interlaminar iliac bone autograft fusion with laminectomy from January 2012 to December 2016 were retrospectively analyzed.Visual analog scale(VAS)score of thoracolumbar pain,the ratio of spinal canal occupancy,height ratio of anterior border to vertebral body,Cobb angle and the nerve function of the American Spinal Injury Association(ASIA)Rating were recorded and compared before and after surgery.Results:All patients underwent the surgery successfully and bone grafts were fused during follow up.No broken nails or broken rods occurred.The VAS scores and Cobb angle at 1 and 12 months after operation were significantly lower than preoperative ones(P<0.001).The height ratio of anterior border to the vertebral body at 1 and 12 months after operation was higher than preoperative one(P<0.001).But there was no significant difference in these parameters between 1 month and 12 months postoperatively.The rate of spinal canal occupancy at 6 months after operation was significantly lower than preoperative(t=20.066,P<0.05).There was a statistical difference in the neurological function of ASIA between 12 months postoperatively and preoperatively(Z=-5.372,P<0.001).The neurological function was significantly improved at 12 months after surgery.Conclusions:Reconstruction of the lamina can reduce the loss of the vertebral body height and the incidence of kyphosis,and avoid the neurological damage caused by the spinal canal stenosis.It is an effective method for thoracolumbar burst fractures.
引文
[1]Gertzbein SD.Scoliosis Research Society.Multicenter spine fracture study.Spine(Phila Pa 1976),1992,17(5):528-540.
[2]Kato S,Murray JC,Kwon BK,et al.Does surgical intervention or timing of surgery have an effect on neurological recovery in the setting of a thoracolumbar burst fracture?J Orthop Trauma,2017,31(4):S38-S43.
[3]Scheer JK,Bakhsheshian J,Fakurnejad S,et al.Evidencebased medicine of traumatic thoracolumbar burst fractures:a systematic review of operative management across 20 years.Global Spine J,2015,5(1):73-82.
[4]Dendrinos GK,Halikias JG,Krallis PN,et al.Factors influencing neurological recovery in burst thoracolumbar fractures.Acta Orthop Belg,1995,61(3):226-234.
[5]Kuklo TR,Polly DW,Owens BD,et al.Measurement of thoracic and lumbar fracture kyphosis:evaluation of intraobserver,interobserver,and technique variability.Spine(Phila Pa1976),2001,26(1):61-65;discussion 66.
[6]Dengfeng Z,Haojie W,Xiao W.Comparative study of the clinical effect and safety of anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture.Open Med(Wars),2015,10(1):410-415.
[7]Lin YC,Fan KF,Liao JC.Two additional augmenting screws with posterior short-segment instrumentation without fusion for unstable thoracolumbar burst fracture-Comparisons with transpedicular grafting techniques.Biomed J,2016,39(6):407-413.
[8]Oprel PP,Tuinebreijer WE,Patka P,et al.Combined anterior-posterior surgery versus posterior surgery for thoracolumbar burst fractures:a systematic review of the literature.Open Orthop J,2010,4:93-100.
[9]Xu GJ,Li ZJ,Ma JX,et al.Anterior versus posterior approach for treatment of thoracolumbar burst fractures:a meta-analysis.Eur Spine J,2013,22(10):2176-2183.
[10]Tang J,Liu Y,Cao Z,et al.Short segment screw fixation without fusion in treatment for unstable thoracolumbar burst fracture.Int J Clin Exp Med,2014,7(12):5681-5685.
[11]吴李勇,黄雪梅,王越,等.后路经椎管减压并脊椎三柱重建技术治疗合并神经损伤的胸腰椎爆裂性骨折.中国骨伤,2018,31(4):322-327.
[12]孙兆云,陈伯华,郭新银,等.后路间接减压治疗不同椎管侵占率的胸腰椎爆裂骨折的效果观察.中华骨与关节外科杂志,2015,8(2):135-139.
[13]Li KC,Hsieh CH,Lee CY,et al.Transpedicle body augmenter:a further step in treating burst fractures.Clin Orthop Relat Res,2005(436):119-125.
[14]Schmid R,Krappinger D,Seykora P,et al.PLIF in thoracolumbar trauma:technique and radiological results.Eur Spine J,2010,19(7):1079-1086.
[15]Kumar S,Kumar S,Arya RK,et al.Thoracolumbar Vertebral Injuries with Neurological Deficit Treated with Posterior Decompression,Short Segment Pedicle Screw Fixation,and Interlaminar Fusion.Asian Spine J,2017,11(6):951-958.
[16]Jang HD,Bang C,Lee JC,et al.Risk factor analysis for predicting vertebral body re-collapse after posterior instrumented fusion in thoracolumbar burst fracture.Spine J,2018,18(2):285-293.
[2]Kato S,Murray JC,Kwon BK,et al.Does surgical intervention or timing of surgery have an effect on neurological recovery in the setting of a thoracolumbar burst fracture?J Orthop Trauma,2017,31(4):S38-S43.
[3]Scheer JK,Bakhsheshian J,Fakurnejad S,et al.Evidencebased medicine of traumatic thoracolumbar burst fractures:a systematic review of operative management across 20 years.Global Spine J,2015,5(1):73-82.
[4]Dendrinos GK,Halikias JG,Krallis PN,et al.Factors influencing neurological recovery in burst thoracolumbar fractures.Acta Orthop Belg,1995,61(3):226-234.
[5]Kuklo TR,Polly DW,Owens BD,et al.Measurement of thoracic and lumbar fracture kyphosis:evaluation of intraobserver,interobserver,and technique variability.Spine(Phila Pa1976),2001,26(1):61-65;discussion 66.
[6]Dengfeng Z,Haojie W,Xiao W.Comparative study of the clinical effect and safety of anterior surgical approach and posterior surgical approach in the treatment of thoracolumbar spinal fracture.Open Med(Wars),2015,10(1):410-415.
[7]Lin YC,Fan KF,Liao JC.Two additional augmenting screws with posterior short-segment instrumentation without fusion for unstable thoracolumbar burst fracture-Comparisons with transpedicular grafting techniques.Biomed J,2016,39(6):407-413.
[8]Oprel PP,Tuinebreijer WE,Patka P,et al.Combined anterior-posterior surgery versus posterior surgery for thoracolumbar burst fractures:a systematic review of the literature.Open Orthop J,2010,4:93-100.
[9]Xu GJ,Li ZJ,Ma JX,et al.Anterior versus posterior approach for treatment of thoracolumbar burst fractures:a meta-analysis.Eur Spine J,2013,22(10):2176-2183.
[10]Tang J,Liu Y,Cao Z,et al.Short segment screw fixation without fusion in treatment for unstable thoracolumbar burst fracture.Int J Clin Exp Med,2014,7(12):5681-5685.
[11]吴李勇,黄雪梅,王越,等.后路经椎管减压并脊椎三柱重建技术治疗合并神经损伤的胸腰椎爆裂性骨折.中国骨伤,2018,31(4):322-327.
[12]孙兆云,陈伯华,郭新银,等.后路间接减压治疗不同椎管侵占率的胸腰椎爆裂骨折的效果观察.中华骨与关节外科杂志,2015,8(2):135-139.
[13]Li KC,Hsieh CH,Lee CY,et al.Transpedicle body augmenter:a further step in treating burst fractures.Clin Orthop Relat Res,2005(436):119-125.
[14]Schmid R,Krappinger D,Seykora P,et al.PLIF in thoracolumbar trauma:technique and radiological results.Eur Spine J,2010,19(7):1079-1086.
[15]Kumar S,Kumar S,Arya RK,et al.Thoracolumbar Vertebral Injuries with Neurological Deficit Treated with Posterior Decompression,Short Segment Pedicle Screw Fixation,and Interlaminar Fusion.Asian Spine J,2017,11(6):951-958.
[16]Jang HD,Bang C,Lee JC,et al.Risk factor analysis for predicting vertebral body re-collapse after posterior instrumented fusion in thoracolumbar burst fracture.Spine J,2018,18(2):285-293.