徐卫星 1徐荣明 2蒋伟宇 2丁伟国 3祝卫民 3张春 3王健 3卢笛3
作者信息
- 1. 浙江中医药大学,浙江杭州310053
- 2. 宁波市第六医院骨科
- 3. 浙江省立同德医院骨科
- 折叠
摘要
Abstract
Objective :To explore the choice of operative approach for thoracolumbar burst fractures and evaluate its clinical effects. Methods: From September 2005 to March 2009, the clinical data of 94 patients with thoracolumbar burst fractures were analyzed retrospectively. Including 59 males and 35 femals with an average age of 36.8 years (ranged from 20 to 63 ). The fractures were classified according to Denis classification: 17 cases of type A, 32 cases of type B, 6 cases of type C, 24 cases of type D, 15 cases of type E. Neurological injuries were classified according to ASIA classification: 3 cases of grade A,4 cases of type B,23 cases of grade C, 38 cases of grade D, 26 cases of grade E. Among the patients, 42 cases were treated with reduction, decompression ,internal fixation with pedicle- screw through posterior approach, meanwhile, of them, 18 cases with posterior-lateral bone graft fusion; 36 cases were treated with decompression, bone graft, through anterior approach, of them, 16 cases with TSRH system fixation and 20 cases with Zeplate system fixation; 16 cases(because of bone block intruded into vertebral canal leading to spinal cord compression ) were treated with anterior and posterior approach,internal fixation with pedicle-screw through posterior approach and subtotal vertebrectomy, decompression, titanium mesh cages bone graft fusion through anterior approach, meanwhile, of them, 8 cases with screw-rod and titanium steel plate system fixation. Results:All patients obtained good results and were followed up from 9 to 52 months with an average of 22.8 months. Cobb angle were corrected from preoperatively (25.00±5.50 )o to postoperatively (4.20± 1.80) o. Height of anterior and posterior border of vertebral body improved from preoperatively (50.80±2.82) ％, (79.30±3.08)％ to postoperatively (94.85± 1.80)％, (98.20± 1.40)％,respectively. The ratio of protruded bones to the spinal canal anteroposterior diameter decreased from preoperatively (33.10±1.40)％ to postoperatively (6.70±1.50)％.Sagittal abnormity were corrected ;posterior convex angle and height were no markedly lost during follow-up; no internal fixation loosening and titanium mesh displacement were found. In the aspect of never function, except for 1 case of grade A there is no recovered others obtained different improvement, among them, from grade A to B was in 2 cases; B to C, D was in 2,2, respectively;C to D,E was 16,7,respectively ;D to E was in 38 cases. Conclusion:The two factors decide surgical methods:the integrity ofposterior ligamentous complex and nervous system function. Anterior approach refers to patients with incomplete spinal cord injury and anterior vertebral canal compression; posterior approach refers to patients with injury of posterior ligamentous complex;combination with anterior and posterior approach refers to patients with two injury factors.关键词
胸椎/腰椎/骨折固定术,内/脊柱融合术/骨移植/减压Key words
Thoracic vertebrae/ Lumbar vertebrae/ Fracture fixation,internal/ Spinal fusion/ Bone transplantation/ Decompression
