摘要
目的探讨经髂骨开窗前路减压、植骨内固定术治疗L4椎体爆裂骨折的临床疗效。方法2001年2月-2006年5月,应用前路髂骨开窗、Z-plate脊柱前路钢板结合椎体间植骨治疗L4椎体爆裂骨折8例。其中男7例,女1例;年龄24～46岁,平均29.3岁。均为L4椎体爆裂骨折,按Denis分型:A型3例,B型5例。神经功能按Frankel分级:C级2例,D级5例,E级1例;其中4例有不同程度的括约肌功能障碍。受伤至手术时间8h～11d。术前L4椎体前缘高度为(13.8±2.3)mm,伤椎Cobb角为(13.2±2.5)°,椎管矢状径为(10.6±3.5)mm。术中植骨量(7.5±1.3)cm3。结果手术均顺利完成,手术时间(142±25)min,术中失血量(436±39)mL。术后切口均Ⅰ期愈合,2例术后短期取骨区轻度疼痛,未予特殊处理,无其他术中、术后相关并发症发生。8例均获随访,随访时间21～52个月,平均24.5个月。术后1周复查X线片和CT示,8例减压均较彻底,椎体前缘高度恢复为(32.5±2.6)mm,伤椎Cobb角为(6.8±3.7)°,椎管矢状径为(19.8±5.1)mm,与术前比较差异均有统计学意义(P<0.01)。至末次随访植骨块位置良好,所有植骨均融合,未见内固定物断裂及松动现象。神经功能Frankel分级:术前C级恢复至D级1例,D级恢复至E级3例,余术后均无变化。术前括约肌功能障碍3例恢复正常,1例好转。结论经髂骨开窗前路手术治疗L4椎体爆裂骨折术中操作简便、椎管减压彻底,可有效维持椎间高度,受损神经功能恢复良好,临床疗效满意。
Objective To evaluate the clinical outcomes of anterior decompression, bone graft and internal fixation in treating fourth lumbar burst fractures with iliac fenestration. Methods From February 2001 to May 2006, 8 cases of fourth lumbar burst fractures were treated by anterior decompression, correction, reduction, iliac autograft, Z-plate internal fixation with iliac fenestration. Of them, there were 7 males and 1 female, aging 24-46 years with an average of 29.3 years, including 3 cases of Denis type A and 5 cases of Denis type B. The decompression, intervertebral height were compared between preoperation and postoperation by CT scanning. According to Frankel assessment for neurological status, 2 cases were at grade C, 5 at grade D and 1 at grade E before operation. Four cases had different degrees of disturbance of sphincter. Time from injury to operation was 8 hours to 11 days. The preoperative height of the anterior border of the L4 vertebral body was （13.8 ± 2.3） mm, the Cobb angel of fractured vertebral body was （13.2 ± 2.5）°, the vertebral canal sagittal diameter of L4 was （10.6 ± 3.5） mm. The bone graft volume was （7.5 ± 1.3） cm^3 during operation. Results Operations were performed successfully. The mean operative time was （142 ± 25） minutes and the mean amount of blood loss was （436 ± 39） mL. The incisions obtained healing by first intention after operation. Two cases suffered donor site pain and recevied no treatment. The follow-up time of 8 cases was from 21 months to 52 months （mean 24.5 months）. At one week after operation, the height of the anterior border of the L4 vertebral body was （32.5 ± 2.6） mm, the Cobb angel of fractured vertebral body was （6.8 ± 3.7）°, and the vertebral canal sagittal diameter of L4 was （19.8 ± 5.1） mm, showing significant difference when compared with those of preoperation （P 〈 0.01）. At the final follow-up, the results showed that the pressure was reduced sufficiently, all autograft fused well, the neurological status improved at Frankel grade from C to D in 1 patient, from D to E in 3 patients, but the others had no improvement. In 4 patients who had disturbance of sphincter, 3 restored to normal and 1 was better off. Conclusion Clinical outcomes of anterior surgery for fourth lumbar burst fractures with iliac fenestration are satisfactory. It can facilicate operation, reduce the pressure sufficiently, maintenance intervertebral height and recover the neurological function.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第7期793-796,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
腰椎
爆裂骨折
内固定
前路手术
Lumbar vertebrae Burst fracture Internal fixation Anterior approach
