摘要
Abstract
Objective To investigate the clinical efficacy of using one-stage posterior subtotal corpectomy and three-column reconstruction for treatment of severe thoracolumbar fractures and dislocation. Methods The 22 patients with severe thoracolumbar fractures and dislocation underwent one-stage subtotal vertebrectomy, titanium mesh implanta-tion and pedicle screw fixation through posterior approach. General information such as operation time, intraoperative blood loss, and complications of the patients were documented. The ASIA scale was used to assess each patient's neu-rological function after the operation. X-ray and CT examination were used to evaluate Cobb's angle, encroachment of the spinal canal, and bone graft fusion. Results Patients had surgical duration of 180～310(211.82±36.09)min, intraoperative blood loss was ＞1 500 ml in 5 cases, 1 000～1 500 ml in 15 cases, ＜1 000 ml in 2 cases. All pa-tients got 12～36 months follow-up. Complications:2 patients were with cerebrospinal fluid leakage, 2 patients with transient nerve root injury, and 6 patients with titanium mesh tilt. At last follow-up, ASIA grade A of 9 patients showed no recovery; 7 of 10 grade B patients improved to grade C, 2 to grade D, and 1 had no recovery; 2 of 3 grade C patients improved to grade D, 1 to grade E. Cobb's angle:the preoperative was 23.95°± 3.86°, which decreased to 6.41°± 1.22°at the postoperative 1 week, correction degree of 17.76°±5.73°;compared with the preoperative, there was statistical significance(P＜0.05). The Cobb's angle was 7.23°±1.78° in the final follow-up,correction degree was 0.91°±1.36°,compared with the postoperative 1 week,there was statistical significance(P＞0.05), In addition, preoperative Wolter scale scores of 1～3 (1.91±0.70) decreased to 0 after the surgery. All cases got one-stage wound healing, without loosening or fracture of internal fixation. Conclusions One-stage posterior subtotal corpectomy with titanium mesh implants is a surgical procedure to treat severe thoracolumbar fractures,which is char-acterized by less trauma, complete decompression, and rapid establishment of three-column stability. Moreover, this operation can decrease the occurrence of posttraumatic thoracolumbar kyphosis. Hence, it is an effective treatment for severe thoracolumbar fractures.关键词
胸腰椎骨折/椎弓根螺钉/椎体次全切除/三柱重建Key words
thoracolumbar fractures/pedicle screw/subtotal vertebral corpectomy/three-column reconstruction分类
医药卫生
