【摘要】 目的:探讨后路经椎板间开窗减压并椎弓根螺钉固定治疗腰椎爆裂骨折伴不完全截瘫的疗效。方法:2003年5月至2006年12月收治腰椎爆裂骨折伴不完全截瘫患者37例,男25例,女12例,年龄18～58岁。脊髓神经功能按Frankel分级,B级5例,C级6例,D级26例。均采用后路经椎板间开窗减压、椎弓根螺钉固定、椎板和横突间植骨治疗,其中单侧椎板开窗减压31例,双侧椎板开窗减压6例。随访椎管减压情况、椎体高度和神经功能恢复情况。结果:术中定位准确,未出现螺钉进入椎管情况,手术时间110～170min,平均145min,术中出血量350～1100ml,平均670ml。术后切口浅表感染2例,发生脑脊液漏2例,经换药后痊愈;1例术后1周缝线断裂致腰背部巨大血肿形成,行血肿清除术后10d切口痊愈。31例得到随访,随访时间8～26个月,平均15.6个月,所有患者椎管减压充分,椎体前缘高度由术前平均52.3%矫正到术后92.7%,后凸角由术前的平均26.4°矫正到术后的平均6.9°。神经功能Frankel分级有1～3级恢复。23例10～12个月时取出内固定,随访未见椎体高度丢失及脊柱成角加重。结论:后路经椎板间开窗减压椎弓根螺钉固定治疗腰椎爆裂骨折伴不完全截瘫可同时解决脊髓减压和脊柱稳定的问题,在正确选择适应证的情况下可取得良好的治疗效果。更多还原

【Abstract】 Objective:To study the effect of posterior fenestration of vertebral plate and internal fixation with pedicle screw instrumentation for lumbar burst fracture.Method:37 patients of lumbar burst fracture with incomplete paraplegia who underwent posterior decompression of vertebral plate,internal fixation with pedicle screw instrumentation and posterolateral bone grafting were analyzed retrospectively between May 2003 and December 2006.There were 25 males and 12 females,aged from 18-25 yrers old.According to Frankel classification,grade B in 5cases,grade C in 6cases and grade D in 25 cases.Among them,31 cases received fenestration of vertebral plate for decompression on one side,6 cases on two sides.Fractured bone intruding spinal canal was removed by knocking reduction or excision.Nail-staff system of China Great Wall was applied in 9 cases,AF in 7 cases,RF-Ⅲ in 21 cases.All cases received bone fusion by auto-iliac graft.Result:31 cases were followed-up from 8 to 26 months,15.6 months on an average.Anterior border height of compressed vertebral bodies was restored from preoperative 52.3% to postoperative 92.7%.Posterior angulation was corrected from preoperative 26.4° to opostoperative 6.9°.According to Frankel ranking for paralysis recovery,31 cases had improved about 1-3 grade.23 cases had removal of internal fixation instruments 10-12 months after operation,the height of vertebral bodies was not lost and angulation of spinal column was not aggravated either.Conclusion:The treatment by posterior fenestration of vertebral plate and internal fixation with pedicle screw can solve the problems of both spinal cord decompression and spine stability for lumbar burst fracture with incomlete paraplegia.It is safe and effective for clinical practice.更多还原