【摘要】 目的:探讨应用颅骨钛板成形加后路植骨重建椎板在治疗胸腰椎骨折手术中的技巧,疗效及适应证。方法:1999年3月至2007年4月治疗胸腰椎骨折伴不同程度神经损伤患者33例,男30例,女3例;年龄21～66岁,平均41岁。受伤部位:T113例,T129例,L116例,L23例,L32例。骨折类型:屈曲型12例,伸展型8例,爆裂型13例。除5例行急诊手术,其余病例发病至手术时间5～12d。行椎弓根螺钉系统内固定,同时行椎板减压后颅骨钛板成形加后路植骨融合重建椎板。25例应用GSS,8例用AF固定。观察术后伤椎管大小、脊柱稳定性、椎体高度的恢复及神经功能恢复情况。结果:33例患者经1～3年的随访,平均25个月。伤椎椎体前缘高度由术前(58±21)%恢复至(96±3)%;椎体后缘(中柱)高度由术前(14±9)%恢复至(98±2)%;Cobb角由术前平均(26±10)°恢复至术后(2±1)°;伤椎管容积由术前(43±20)%恢复至术后(93±6)%。结论:颅骨钛板成形加后路植骨重建椎板治疗胸腰椎骨折,操作简单、安全,椎板减压后扩大了椎管,杜绝了继发性椎管狭窄,重建了后柱结构,增加了脊柱稳定性。更多还原

【Abstract】 Objective:To discuss the surgical skill,treatment effect and indications for reconstruction of vertebral lamina with skull titanium plate and autograft in the treatment of thoracolumbar vertebrae fracture. Methods:From March 1999 to April 2007,33 patients with thoracolumbar vertebrae fracture combined nerve injury were treated by reconstruction of vertebral lamina with skull titanium plate and autograft including 30 males and 3 females with an average age of 41 years ranging from 21 to 66. The fracture involved 3 cases in T11,9 in T12,16 in L1,3 in L2 and 2 in L3. There were 12 cases with flexion fracture,8 with extension fracture,and 13 with burst fracture. Five cases performed emergency operation and in the others the time from injury to operation was 5 to 12 days. GSS fixation was applied in 25 cases and AF in 8. The volume of vertebral canal,the stability of the spine,the height of vertebrae,and the nerve function were observed before and after operation. Results:These 33 patients were followed up for 1 to 3 years(means 25 months). The height of anterior column of the involved vertebrae changed from 58% to 96%,the cobb angle return from average of 26 degree to 2 degree,the volume of vertebral canal extended from 43% to 92%,respectively,when compared between preoperatively and postoperatively. Conclusion:Reconstruction of vertebral lamina with skull titanium plate and autograft which is a simple and safe treatment for thoracolumbar vertebrae fracture can increase the stability of spine and avoid second canal stenosis.更多还原