本文選題：前外側(cè)入路　切入點：側(cè)前方減壓術(shù)　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討經(jīng)前外側(cè)入路行減壓植骨融合內(nèi)固定術(shù)治療胸腰段爆裂骨折合并神經(jīng)損傷患者在后凸畸形矯正及維持、椎體高度恢復(fù)和保持、椎管減壓效果、神經(jīng)功能改善、臨床治療效果方面的手術(shù)優(yōu)勢。方法:經(jīng)前外側(cè)入路行側(cè)前方減壓植骨融合內(nèi)固定術(shù)治療胸腰段(T11-L2)爆裂骨折伴有神經(jīng)癥狀的患者22例。根據(jù)影像資料,比較患者在術(shù)前、術(shù)后及末次隨訪中脊柱后凸角(°)、傷椎前緣高度壓縮百分比(%)、椎管正中矢狀徑占比(%)的變化;有無繼發(fā)后凸畸形、椎體高度丟失及內(nèi)固定失效等情況。根據(jù)臨床表現(xiàn),比較患者術(shù)后與術(shù)前ASIA(美國脊髓損傷協(xié)會)脊髓損傷水平評分;術(shù)前、術(shù)后及末次隨訪的JOA(日本矯形外科學(xué)會)下腰痛評分,統(tǒng)計術(shù)后及末次隨訪改善率,比較術(shù)后與末次隨訪的優(yōu)良率。結(jié)果:22例患者獲得(18±7.2)個月隨訪,1例患者術(shù)后出現(xiàn)嚴重腹痛腹脹,對癥治療后好轉(zhuǎn);2例患者術(shù)后出現(xiàn)肋間神經(jīng)支配區(qū)感覺障礙,神經(jīng)營養(yǎng)藥物治療后1例恢復(fù)1例好轉(zhuǎn);所有患者均未出現(xiàn)其他并發(fā)癥。在影響學(xué)指標變化上,脊柱后凸角:術(shù)前(20.53±4.05)°、術(shù)后(5.94±1.08)°、末次隨訪(6.56±0.98)°,術(shù)后與術(shù)前比較差異有統(tǒng)計學(xué)意義(P=0.01)、末次隨訪與術(shù)前比較差異有統(tǒng)計意義(P=0.01)、末次隨訪與術(shù)后比較差異無統(tǒng)計學(xué)意義(P=0.08);傷椎前緣高度壓縮百分比:術(shù)前(51.18±7.67)%、術(shù)后(91.77±2.31)%、末次隨訪(90.55±4.28)°,術(shù)后與術(shù)前比較差異有統(tǒng)計學(xué)意義(P=0.01)、末次隨訪與術(shù)前比較差異有統(tǒng)計學(xué)意義(P=0.01)、末次隨訪與術(shù)后比較差異無統(tǒng)計學(xué)意義(P=0.14);椎管正中矢狀徑占比:術(shù)前(34.82±5.14)%、術(shù)后(3.16±0.58)%、末次隨訪(3.30±0.48)%,術(shù)后與術(shù)前比較差異有統(tǒng)計學(xué)意義(P=0.01)、末次隨訪與術(shù)前比較差異有統(tǒng)計學(xué)意義(P=0.01)、末次隨訪與術(shù)后比較差異無統(tǒng)計學(xué)意義(P=0.13)。所有患者在術(shù)后及隨訪中均未出現(xiàn)繼發(fā)后凸畸形、椎體高度明顯丟失及內(nèi)固定失效的情況。在術(shù)后與術(shù)前ASIA評分比較上除2例術(shù)前ASIA評分為A級的患者無提高外,12例患者得到1級提高,8例患者得到2級提高。JOA評分改善率上術(shù)后優(yōu)良患者14例,末次隨訪優(yōu)良患者19例,末次隨訪優(yōu)良率86.36%與術(shù)后優(yōu)良率63.65%比較有明顯提高。結(jié)論:經(jīng)前外側(cè)入路行側(cè)前方減壓植骨融合內(nèi)固定術(shù)治療合并神經(jīng)損傷的胸腰段爆裂骨折解剖入路相對簡單,避免損傷胸腔、腹腔器官減少手術(shù)并發(fā)癥;能有效糾正和預(yù)防后凸畸形;恢復(fù)并維持椎體前緣高度;直視下椎管減壓充分,鈦網(wǎng)重建前中柱同時行后路內(nèi)固定加強脊柱穩(wěn)定性;患者神經(jīng)功能恢復(fù)滿意,生活質(zhì)量提高,可作為治療胸腰段爆裂骨折伴神經(jīng)癥狀的有效手術(shù)方式。
[Abstract]:Objective: to investigate the treatment of thoracolumbar burst fracture with nerve injury through anterolateral approach with decompression, bone grafting and internal fixation in correction and maintenance of kyphosis, recovery and maintenance of vertebral body height, decompression of spinal canal and improvement of nerve function. Methods: 22 cases of thoracolumbar T11-L2) burst fracture with neurological symptoms were treated by anterior decompression and bone graft fusion and internal fixation via anterolateral approach. Changes of kyphosis angle (擄擄, compression percentage of anterior edge height of injured vertebrae, ratio of median sagittal diameter of spinal canal), secondary kyphosis, loss of vertebral body height and failure of internal fixation, etc. The scores of postoperative and preoperative ASIA (American Spinal Cord injury Association) spinal cord injury level, preoperative, postoperative and final follow-up of JOA( Japanese Orthopaedic Surgical Association) low back pain score were compared, and the improvement rates of postoperative and last follow-up were calculated. Results 22 patients received 18 鹵7.2 months follow-up, 1 patient developed severe abdominal pain and abdominal distension, 2 patients improved after symptomatic treatment and developed sensory disturbance of intercostal innervation area. 1 case recovered after neurotrophic drug treatment, 1 case improved, no other complications occurred in all patients. The kyphosis angle was 20.53 鹵4.05 擄before operation, 5.94 鹵1.08 擄after operation, and 6.56 鹵0.98 擄at the last follow-up. The difference between postoperative and preoperative was statistically significant (P < 0.01). The percentage of anterior height compression was 51.18 鹵7.67 before operation, 91.77 鹵2.31 after operation, and 90.55 鹵4.28 擄at the last follow-up. There was a significant difference between postoperation and pre-operation, and there was significant difference between last follow-up and pre-operation. There was no significant difference between the last follow-up and postoperative. The ratio of the median sagittal diameter of the spinal canal was 34.82 鹵5.14 before operation, 3.16 鹵0.58 after operation, and 3.30 鹵0.48 at the last follow-up. The difference between postoperative and preoperative was statistically significant (P 0.01). There was a significant difference between the last follow-up and preoperative, but there was no significant difference between the last follow-up and postoperative. There were no secondary kyphosis in all patients after operation and follow-up. The loss of vertebral height and the failure of internal fixation. In comparison with preoperative ASIA score, 12 patients received grade 1 improvement and 8 patients received grade 2 improvement, except for 2 patients with ASIA grade A before operation. The rate of improvement was good in 14 cases. There were 19 excellent patients at the last follow-up. The excellent and good rate of the last follow-up was 86.36% and the excellent and good rate was 63.65%. Conclusion: the anatomic approach for thoracolumbar burst fracture with nerve injury is relatively simple through anterolateral approach and lateral anterior decompression and bone grafting fusion fixation. It can effectively correct and prevent kyphosis, restore and maintain the height of the anterior edge of vertebral body, decompression of vertebral canal under direct vision, reconstruction of anterior and middle column of titanium mesh and internal fixation of posterior approach to strengthen the stability of spine. The patients with satisfactory recovery of nerve function and improved quality of life can be used as an effective surgical method for the treatment of thoracolumbar burst fracture with neurological symptoms.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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本文編號：1650102