本文選題：胸腰椎骨折 + 植骨　； 參考：《中華骨與關節(jié)外科雜志》2016年03期

【摘要】：背景:目前,對于嚴重的爆裂性胸腰椎骨折的手術入路、脊髓神經(jīng)的減壓和植骨重建椎體前中柱等問題的爭議較多。目的:探討后路經(jīng)單側椎管脊髓神經(jīng)減壓、椎體內植骨成形治療嚴重胸腰椎骨折伴有重度椎管狹窄的術后療效及影像學評估。方法:2010年6月至2014年6月我院收治64例McAfee分型中C、E型胸腰椎骨折伴有重度椎管狹窄患者。對其行后路椎弓根螺釘撐開復位、經(jīng)單側椎管脊髓神經(jīng)減壓、椎體內植骨成形術。術前、術后2周及1年后分別行X線、螺旋CT三維圖像重建檢查,部分患者追加MRI檢查。所有患者均于傷后2周內完成手術。術后坐、行走時佩戴胸腰支具固定3個月。評價術前、術后及終末隨訪時椎體前緣和后緣高度、Cobb角、椎管正中矢狀徑及截癱恢復情況。采用CT三維圖像重建評價突入椎管骨塊復位和植骨分布情況。結果:隨訪時間13~27個月,平均18.62個月。由骨折塊移位造成的對硬膜囊和神經(jīng)根的卡壓減壓較徹底,植骨分布較廣泛、均勻。分別對比術后與術前、終末隨訪與術前的傷椎體前緣高度、Cobb角、椎體正中矢狀徑,均存在顯著差異(P0.05),而終末隨訪與術后對比無顯著差異(P0.05)。椎體后緣高度在各時間段比較均無顯著差異(P0.05)。所有手術切口均一期愈合。術后無腦脊液漏、椎弓根釘棒斷裂及松動等并發(fā)癥發(fā)生。結論:后路椎弓根螺釘撐開復位、經(jīng)單側椎管脊髓神經(jīng)減壓、椎體內植骨成形術能讓椎管獲得直接、充分的減壓,植骨分布廣泛、均勻,能有效恢復傷椎高度及重建椎體強度,是一種解決胸腰椎骨折伴重度椎管狹窄的有效方法。
[Abstract]:Background: at present, decompression of spinal cord nerve and reconstruction of anterior and middle column of vertebral body are controversial for severe thoracolumbar fracture.Objective: to evaluate the effect and imaging evaluation of posterior decompression of unilateral spinal cord nerve and bone graft in the treatment of severe thoracolumbar fractures with severe spinal stenosis.Methods: from June 2010 to June 2014, 64 cases of thoracolumbar fracture with severe spinal canal stenosis in McAfee classification were treated in our hospital.The posterior pedicle screw was repositioned and decompressed by unilateral spinal cord nerve and bone graft was performed.Before operation, 2 weeks and 1 year after operation, X-ray and spiral CT were performed respectively, and some patients were examined with MRI.All patients completed the operation within 2 weeks after injury.Postoperative sitting, walking wearing chest and waist support fixed for 3 months.To evaluate the height of Cobb angle, the median sagittal diameter of spinal canal and the recovery of paraplegia.Ct three-dimensional image reconstruction was used to evaluate the reduction and distribution of bony bone into the vertebral canal.Results: the follow-up time was 13 ~ 27 months (mean 18.62 months).The compression and decompression of the dural sac and nerve root caused by the displacement of the fracture block is relatively thorough, and the bone graft distribution is wider and more uniform.There were significant differences in the height of the anterior edge of the injured vertebra and the median sagittal diameter of the vertebral body between postoperative and preoperative, and between the end follow-up and the operation, but there was no significant difference between the end follow-up and postoperative comparison.There was no significant difference in the posterior edge height of vertebrae in all time periods (P 0.05).All incisions were healed in the first stage.There was no cerebrospinal fluid leakage, fracture and loosening of pedicle screw.Conclusion: posterior pedicle screw distraction reduction, unilateral spinal nerve decompression and bone-grafting can make the vertebral canal decompression directly and fully, and the bone graft is widely distributed and uniform. It can effectively restore the height of injured vertebrae and reconstruct the strength of vertebral body.It is an effective method to solve thoracolumbar fracture with severe spinal canal stenosis.
【作者單位】： 遵義醫(yī)學院附屬醫(yī)院脊柱外科;
【基金】：貴州省科技廳科學技術基金課題(黔科合J字[2010]2179號) 遵義醫(yī)學院博士啟動基金課題(遵醫(yī)院辦發(fā)[2010]1)
【分類號】：R687.3

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本文編號：1764092