【摘要】 目的探讨经后路270°减压并脊椎三柱重建技术治疗重度胸腰椎爆裂性骨折的临床疗效。方法对自2008年10月～2010年12月收治的24例累及三柱的重度胸腰椎爆裂性骨折,均采用经后路270°减压并脊椎三柱重建技术治疗。结果切口均一期愈合。术后均获得随访,时间4～28个月,平均16.7个月;植骨全部获得骨性愈合,无假关节形成,无一例出现内固定松脱、移位、断裂等;神经功能情况:除9例无明显恢复外,其余患者均有不同程度的恢复。术后伤椎前缘高度、后凸畸形(Cobb角)、伤椎椎管容积较术前明显改善,差异有统计学意义(P<0.05)。结论采用经后路270°减压并脊椎三柱重建技术治疗重度胸腰椎爆裂性骨折,可以从单一入路同时完成骨折复位、椎管彻底减压和脊椎的三柱重建、即刻稳定脊柱,在减少手术创伤的同时,达到前后联合入路所能取得的手术效果,是一种安全、有效、值得推广的手术方式。更多还原

【Abstract】 Objective To investigate the clinical effects of posterior 270° decompression and three-column(anterior,middle and posterior) reconstruction for severe thoracolumbar burst fracture.Methods From October 2008 to December 2010,24 patients with severe thoracolumbar burst fracture which resulted in three-column injury were treated with posterior 270° decompression and three-column reconstruction.Results The cut all healed after the surgery.All the patients were followed up for 4 to 28 months,16.7 months on average.Knitting of bone graft was observed at the last visits.Neither pseudarthrosis nor slipping,shifting or rupture of the internal fixation was found.As far as the nervous function was concerned,except nine patients did not show apparent recovery,the rest of patients recovered in various degrees.Postoperative costal margin,Cobb’s corner and neural canal size improved significantly(P <0.05).Conclusion By adopting posterior 270°decompression and three-column reconstruction in the cure for severe thoracolumbar burst fracture,the aim of fracture reduction,spinal canal decompression and three-column reconstruction can be realized at the same time and through a single passage,which not only stabilizes the spine instantly and minimizes trauma but also achieves the same effects with the combined anterior and posterior approach.The present approach proves to be a safe,effective and recommendable approach.更多还原