• 四川大學(xué)華西醫(yī)院骨科（成都，610041）;

目的 探討經(jīng)后路椎體次全切除加椎間支撐植骨治療胸腰椎爆裂性骨折及骨折脫位的早期臨床療效。方法 2009 年1 月－ 2010 年12 月，采用經(jīng)后路椎體次全切除加椎間支撐植骨治療胸腰椎爆裂性骨折及骨折脫位20 例。其中男14 例，女6 例；年齡19 ～ 47 歲，平均36.1 歲。致傷原因：高處墜落傷12 例，交通事故傷6 例，重物砸傷2 例。骨折按照AO 分型：A3 型10 例，B2 型8 例，C2 型2 例。單節(jié)段損傷8 例，雙節(jié)段損傷12 例。合并骨折脫位12 例，側(cè)方移位6 例，患者椎管內(nèi)骨性占位明顯。術(shù)前Cobb 角（30.2 ± 3.9）°。Frankel 神經(jīng)功能分級：B 級4 例，C 級9 例，D 級7 例。受傷至手術(shù)時間1 ～ 12 d，平均4.5 d。 結(jié)果 手術(shù)切口均Ⅰ期愈合，無切口感染。20 例均獲隨訪，隨訪時間8 ～ 16 個月，平均12個月。植骨均骨性愈合，愈合時間6 ～ 9 個月，平均7 個月。末次隨訪時Frankel 神經(jīng)功能分級均較術(shù)前恢復(fù)1 ～ 3 級，其中C 級1 例、D 級2 例、E 級17 例。末次隨訪時Cobb 角為（6.5 ± 4.2）°，與術(shù)前比較差異有統(tǒng)計學(xué)意義（t=2.39，P=0.00）。無斷釘、斷棒、螺釘松動、椎體間支撐內(nèi)植物下沉等并發(fā)癥發(fā)生。 結(jié)論 經(jīng)后路椎體次全切除加椎間支撐植骨可以很好進(jìn)行椎管內(nèi)減壓，恢復(fù)脊柱穩(wěn)定性，植骨愈合率高，神經(jīng)功能恢復(fù)良好；但術(shù)中出血相對較多，對術(shù)者技術(shù)要求較高。

引用本文： 高博,幸?guī)V,孔清泉,宋躍明,劉浩,李濤,龔全,曾建成. 經(jīng)后路椎體次全切除加椎間支撐植骨治療胸腰椎爆裂性骨折及骨折脫位的早期療效觀察. 中國修復(fù)重建外科雜志, 2012, 26(5): 542-545. doi: 復(fù)制

1. Holdsworth F. Fractures, dislocation and fracture-dislocation of the spine. J Bone Joint Surg (Am), 1970, 52(8): 1534-1551.
2. 歐云生, 蔣電明, 權(quán)正學(xué), 等. 納米羥基磷灰石/聚酰胺66復(fù)合生物活性人工椎體在胸腰椎骨折前路重建手術(shù)中的應(yīng)用. 中國修復(fù)重建外科雜志, 2007, 21(10): 1084-1089.
3. Kaneda K, Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg (Am), 1997, 79(1): 69-83.
4. Knop CK, Fabian HF, Bastian L, et al. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976), 26(1): 88-99.
5. 陳善明, 陳琦, 劉學(xué)軍. 經(jīng)椎弓根植骨釘棒固定治療胸腰椎骨折. 中國修復(fù)重建外科雜志, 2010, 24(2): 245-246.
6. Suk SI, Kim JH, Lee SM, et al. Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 28(18): 2170-2175.
7. Aybery G, Ozverren 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.
8. 馬毅, 鄧樹才, 劉建坤, 等. 經(jīng)后路椎弓根釘內(nèi)固定加鈦網(wǎng)骨移植椎間融合治療胸腰椎爆裂骨折. 中華創(chuàng)傷骨科雜志, 2009, 11(1): 22-25.
9. 李平元, 蘇小桃, 歐軍, 等. I期后路270°減壓、鈦網(wǎng)重建術(shù)治療嚴(yán)重胸腰椎三柱骨折. 中華創(chuàng)傷雜志, 2009, 25(6): 532-534.
10. 林慰光, 林本丹, 胡奕山. 經(jīng)后路椎體次全切除后鈦網(wǎng)支撐置入加椎弓根釘內(nèi)固定治療腰椎爆裂性骨折的初步報告. 中華創(chuàng)傷骨科雜志, 2010, 12(5): 489-291.
11. 李建江, 馬信龍, 鄧樹才, 等. 經(jīng)后路椎體次全切除及重建治療嚴(yán)重胸腰椎骨折. 中華骨科雜志, 2011, 31(7): 761-766.
12. 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.
13. Gurr KR, McAfee PC, Ahih CM. Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. A calf-spine model. J Bone Joint Surg (Am), 1988, 70(8): 1182-1191.
14. 陳天劍, 豐干均, 喬俊, 等. 后路椎弓根固定加椎間植骨治療胸腰椎爆裂骨折. 中華創(chuàng)傷雜志, 2009, 25(10): 890-893.
15. Wang MY, Kim DH, Kim KA. Correction of late traumatic thoracic and thoracolumbar hypnotic spinal deformities using posteriorly placed intervertebral distraction cages. Neurourgery, 2008, 62(3 Suppl 1):.
16. 劉蘭澤, 陳先, 盧占彬, 等. 椎弓根螺釘固定治療胸腰椎骨折術(shù)后斷釘斷棒原因分析. 中國脊柱脊髓雜志, 2006, 16(8): 614-618.
17. Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
18. Hakalo J, Wroński J. Complications of a transpedicular stabilization of thoraco-lumbar burst fractures. Neurol Neurochir Pol, 2006, 40(2): 134-139.
19. Vaccaro AR, Lim MR, Hurtbert RJ, et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Diserd Tech, 2006, 19(1): 1-10.
20. -172.
  1. 1. Holdsworth F. Fractures, dislocation and fracture-dislocation of the spine. J Bone Joint Surg (Am), 1970, 52(8): 1534-1551.
  2. 2. 歐云生, 蔣電明, 權(quán)正學(xué), 等. 納米羥基磷灰石/聚酰胺66復(fù)合生物活性人工椎體在胸腰椎骨折前路重建手術(shù)中的應(yīng)用. 中國修復(fù)重建外科雜志, 2007, 21(10): 1084-1089.
  3. 3. Kaneda K, Taneichi H, Abumi K, et al. Anterior decompression and stabilization with the kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg (Am), 1997, 79(1): 69-83.
  4. 4. Knop CK, Fabian HF, Bastian L, et al. Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976), 26(1): 88-99.
  5. 5. 陳善明, 陳琦, 劉學(xué)軍. 經(jīng)椎弓根植骨釘棒固定治療胸腰椎骨折. 中國修復(fù)重建外科雜志, 2010, 24(2): 245-246.
  6. 6. Suk SI, Kim JH, Lee SM, et al. Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 28(18): 2170-2175.
  7. 7. Aybery G, Ozverren 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.
  8. 8. 馬毅, 鄧樹才, 劉建坤, 等. 經(jīng)后路椎弓根釘內(nèi)固定加鈦網(wǎng)骨移植椎間融合治療胸腰椎爆裂骨折. 中華創(chuàng)傷骨科雜志, 2009, 11(1): 22-25.
  9. 9. 李平元, 蘇小桃, 歐軍, 等. I期后路270°減壓、鈦網(wǎng)重建術(shù)治療嚴(yán)重胸腰椎三柱骨折. 中華創(chuàng)傷雜志, 2009, 25(6): 532-534.
  10. 10. 林慰光, 林本丹, 胡奕山. 經(jīng)后路椎體次全切除后鈦網(wǎng)支撐置入加椎弓根釘內(nèi)固定治療腰椎爆裂性骨折的初步報告. 中華創(chuàng)傷骨科雜志, 2010, 12(5): 489-291.
  11. 11. 李建江, 馬信龍, 鄧樹才, 等. 經(jīng)后路椎體次全切除及重建治療嚴(yán)重胸腰椎骨折. 中華骨科雜志, 2011, 31(7): 761-766.
  12. 12. 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.
  13. 13. Gurr KR, McAfee PC, Ahih CM. Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. A calf-spine model. J Bone Joint Surg (Am), 1988, 70(8): 1182-1191.
  14. 14. 陳天劍, 豐干均, 喬俊, 等. 后路椎弓根固定加椎間植骨治療胸腰椎爆裂骨折. 中華創(chuàng)傷雜志, 2009, 25(10): 890-893.
  15. 15. Wang MY, Kim DH, Kim KA. Correction of late traumatic thoracic and thoracolumbar hypnotic spinal deformities using posteriorly placed intervertebral distraction cages. Neurourgery, 2008, 62(3 Suppl 1):.
  16. 16. 劉蘭澤, 陳先, 盧占彬, 等. 椎弓根螺釘固定治療胸腰椎骨折術(shù)后斷釘斷棒原因分析. 中國脊柱脊髓雜志, 2006, 16(8): 614-618.
  17. 17. Shen WJ, Liu TJ, Shen YS. Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine (Phila Pa 1976), 2001, 26(9): 1038-1045.
  18. 18. Hakalo J, Wroński J. Complications of a transpedicular stabilization of thoraco-lumbar burst fractures. Neurol Neurochir Pol, 2006, 40(2): 134-139.
  19. 19. Vaccaro AR, Lim MR, Hurtbert RJ, et al. Surgical decision making for unstable thoracolumbar spine injuries: results of a consensus panel review by the Spine Trauma Study Group. J Spinal Diserd Tech, 2006, 19(1): 1-10.
  20. 20. -172.