经后路椎管前方减压三柱重建治疗胸腰椎单节段不稳定骨折_《中国修复重建外科杂志》

作者：

刘佐忠 , 柯珍勇 , 陈亮 , 晏铮剑 , 陈富 , 邓忠良

重庆医科大学附属第二医院骨科（重庆，400010）;

关键词：

不稳定胸腰椎骨折后侧入路椎管减压脊柱重建

DOI：

10.7507/1002-1892.20130181

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的探讨单纯经后路椎管前方减压、三柱重建治疗胸腰椎单节段不稳定骨折的临床疗效。方法 2009年3月－2011年10月，收治胸腰椎单节段不稳定骨折39例。其中男32例，女7例；年龄25～68岁，平均43.8岁。致伤原因：高处坠落伤17例，砸伤10例，交通事故伤4例，其他8例。病变累及节段：T10 1例，T11 9例，T12 6例，L1 14例，L2 7例，L3 1例，L4 1例。术前Frankel分级：A级5例，B级5例，C级9例，D级14例，E级6例。伤椎后凸Cobb角（26.7 ± 7.1）°，椎体高度丢失37.5% ± 9.5%，椎管占位73.7% ± 11.3%。伤后至手术时间1～4 d，平均2.5 d。均采用经后路椎管前方减压、钛笼植入前中柱、后柱减压融合、三柱重建治疗。对手术前后椎体高度恢复情况、后凸畸形矫正程度、椎管减压是否彻底、术后神经功能恢复状况等进行评价。结果术后1例出现截瘫平面上升、1例尿路感染、2例压疮；余患者均未出现切口感染、神经损伤症状加重或新的神经症状，患者切口均Ⅰ期愈合。39例均获随访，随访时间12～36个月，平均27个月。患者术后无腰背部疼痛加重；无螺钉松动、断钉、断棒等并发症发生；未出现钛合金电解、钛笼沉降断裂。术后2年影像学检查提示椎管减压彻底，椎体高度恢复满意，生理曲度维持良好。末次随访时Frankel分级为A级1例，B级2例，C级2例，D级10例，E级24例，较术前显著改善（P lt; 0.05）。术后即刻与末次随访时后凸Cobb角分别为（6.3 ± 2.1）°和（6.5 ± 2.4）°，伤椎高度丢失分别为7.9% ± 2.7%和8.2% ± 3.0%，均较术前显著改善（P lt; 0.05）。结论经后路椎管前方减压、三柱重建治疗胸腰椎单节段不稳定骨折，能彻底减压、三柱重建、即刻恢复脊柱稳定性，是一种理想的手术方式。

引用本文： 刘佐忠,柯珍勇,陈亮,晏铮剑,陈富,邓忠良. 经后路椎管前方减压三柱重建治疗胸腰椎单节段不稳定骨折. 中国修复重建外科杂志, 2013, 27(7): 824-828. doi: 10.7507/1002-1892.20130181 复制

1.	Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine (Phila Pa 1976), 2006, 31(8): 859-868.
2.	Tezer M, Ertuer RE, Ozturk C, et al. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop, 2005, 29(2): 78-82.
3.	McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4.	Benson DR, Burkus JK, Montesano PX, et al. Unstable Thoracolumbar and lumbar burst fractures treated with the AO fixateur inerne. J Spinal Disord, 1992, 5(3): 335-343.
5.	Willen J, Anderson J, Toomoka K, et al. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord, 1990, 3(1): 39-46.
6.	Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of thoracolumbar junction. J Trauma, 1988, 28(8): 1188-1194.
7.	Mcdonough PW, Davis R, Tribus C, et al. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976), 2004, 29(17): 1901-1909.
8.	徐兆万, 隋国侠, 王炳武, 等. 有限减压相邻节段植骨内固定术治疗胸腰椎骨折. 中国矫形外科杂志, 2007, 15(2): 91-93.
9.	Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
10.	袁文. 脊柱脊髓损伤诊治的历史、现状与展望. 中华创伤杂志, 2007, 23(9): 641-642.
11.	马维虎, 徐荣明, 冯建翔, 等. 经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折. 骨与关节损伤杂志, 2003, 18(8): 511-513.
12.	Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
13.	Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumbar and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
14.	侯力强, 李建军, 汪力平, 等. 后路椎管三方减压病椎植骨重建治疗胸腰椎爆裂性骨折. 浙江创伤外科杂志, 2010, 15(6): 782-783.
15.	Tomita K, Kawahara N, Murakami H, et al. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci, 2006, 11(1): 3-12.
16.	Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1): 8-14.
17.	Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1): E33-40.
18.	Haiyun Y, Rui G, Shucai D, et al. Three-column reconstruction through single posterior approach for treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976), 2010, 35(8): E295-302.
19.	Young W, Flamm ES. Effect of high-dose corticosteroid therapy on blood flow, evoked potentials, and extracellular calcium in experimental spinal injury. J Neurosurg, 1982, 57(5): 667-673.
20.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
21.	Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa1976), 2004, 29(7): 803-814.

1. Korovessis P, Baikousis A, Zacharatos S, et al. Combined anterior plus posterior stabilization versus posterior short-segment instrumentation and fusion for mid-lumbar (L2-L4) burst fractures. Spine (Phila Pa 1976), 2006, 31(8): 859-868.
2. Tezer M, Ertuer RE, Ozturk C, et al. Conservative treatment of fractures of the thoracolumbar spine. Int Orthop, 2005, 29(2): 78-82.
3. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine (Phila Pa 1976), 1994, 19(15): 1741-1744.
4. Benson DR, Burkus JK, Montesano PX, et al. Unstable Thoracolumbar and lumbar burst fractures treated with the AO fixateur inerne. J Spinal Disord, 1992, 5(3): 335-343.
5. Willen J, Anderson J, Toomoka K, et al. The natural history of burst fractures at the thoracolumbar junction. J Spinal Disord, 1990, 3(1): 39-46.
6. Reid DC, Hu R, Davis LA, et al. The nonoperative treatment of burst fractures of thoracolumbar junction. J Trauma, 1988, 28(8): 1188-1194.
7. Mcdonough PW, Davis R, Tribus C, et al. The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976), 2004, 29(17): 1901-1909.
8. 徐兆万, 隋国侠, 王炳武, 等. 有限减压相邻节段植骨内固定术治疗胸腰椎骨折. 中国矫形外科杂志, 2007, 15(2): 91-93.
9. Wood K, Buttermann G, Mehbod A, et al. Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg (Am), 2003, 85-A(5): 773-781.
10. 袁文. 脊柱脊髓损伤诊治的历史、现状与展望. 中华创伤杂志, 2007, 23(9): 641-642.
11. 马维虎, 徐荣明, 冯建翔, 等. 经椎弓根植骨和椎体成形术治疗胸腰椎爆裂性骨折. 骨与关节损伤杂志, 2003, 18(8): 511-513.
12. Wood KB, Bohn D, Mehbod A. Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech, 2005, 18 Suppl: S15-23.
13. Heary RF, Salas S, Bono CM, et al. Complication avoidance: thoracolumbar and lumbar burst fractures. Neurosurg Clin N Am, 2006, 17(3): 377-388.
14. 侯力强, 李建军, 汪力平, 等. 后路椎管三方减压病椎植骨重建治疗胸腰椎爆裂性骨折. 浙江创伤外科杂志, 2010, 15(6): 782-783.
15. Tomita K, Kawahara N, Murakami H, et al. Total en bloc spondylectomy for spinal tumors: improvement of the technique and its associated basic background. J Orthop Sci, 2006, 11(1): 3-12.
16. Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1): 8-14.
17. Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1): E33-40.
18. Haiyun Y, Rui G, Shucai D, et al. Three-column reconstruction through single posterior approach for treatment of unstable thoracolumbar fracture. Spine (Phila Pa 1976), 2010, 35(8): E295-302.
19. Young W, Flamm ES. Effect of high-dose corticosteroid therapy on blood flow, evoked potentials, and extracellular calcium in experimental spinal injury. J Neurosurg, 1982, 57(5): 667-673.
20. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14): 1503-1507.
21. Verlaan JJ, Diekerhof CH, Buskens E, et al. Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa1976), 2004, 29(7): 803-814.

《中国修复重建外科杂志》

经后路椎管前方减压三柱重建治疗胸腰椎单节段不稳定骨折

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《中国修复重建外科杂志》

经后路椎管前方减压三柱重建治疗胸腰椎单节段不稳定骨折

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