【摘要】 目的　探讨后方入路椎管环形减压与内固定治疗胸腰椎骨折伴脊髓损伤的手术要点和临床效果。方法　 5 8例胸腰椎骨折伴脊髓损伤的患者行后方入路椎管环形、半环形减压。哈氏撑开棒加棘突钢丝固定 15例 ,Luque棒固定 7例 ,哈氏棒与Luque棒联合固定 4例 ,椎弓根器械固定 32例。本组病例根据伤情和手术方法不同 ,分别行椎板关节突、椎体间、半椎板及横突间植骨融合。结果　术后随访 6个月～ 7年 6个月 ,平均 3年 2个月。 5 8例术后X线片显示伤椎前缘高度从 46 %恢复到 88 6 % ,脊椎后凸Cobb角从 17 6°降至 2° ,CT显示椎管矢状径基本恢复正常 ,硬膜囊前方无受压现象 ,神经功能恢复有效率 :完全瘫 (A→B)为 11 1% ,不完全性瘫为 10 0 %。结论　后方入路环形减压能一次性清理脊髓马尾周围致压物和完成内固定 ,稳定脊柱 ,最大限度地创造神经功能恢复的条件 ,减少继发性脊髓损伤和并发症的发生。本术式减压充分 ,固定可靠 ,是治疗胸腰椎骨折伴脊髓损伤的有效方法更多还原

【Abstract】 HT5”H]Objective [HT5”SS]To discuss the operative principle and clinical effect of circular decompression and internal fixation through posterior approach for the treatment of thoracolumbar vertebrae fracture combined with spinal cord injury.[HT5”H]Methods [HT5”SS]58 cases of thoracolumbar vertebrae fracture combined with spinal cord injury were treated with circular and semicircular decompression operation through posterior approach;15 cases had fixation with Harrington’s rods combined with steel wiring at the spinous process,7 with Luque’s rods,4 with Harrington’s rods and Luque’s rods,and 32 with apparatus of pedicle fixation.Bone graftings of articular process of vertebral lamina,interspinous,half vertebral lamina and intertransverse were performed for the individual cases according to the local conditions and operation methods.[HT5”H]Results [HT5”SS]The follow up period ranged from 6 months to 7 years and 6 months,with an average of 3 years and 2 months.The results of X ray examination showed that the mean height of anterior border of injured vertebrae recovered from 46% of the normal height before operation to 88 6% postoperatively,and the Cobb’s angle decreased from 17.6° to 2°.The results of CT demonstrated that the sagittal diameter of vertebral canal nearly recoverd to normal,the anterior of duro sac was not compressed,the rate of nerve function recovery was 11.1% in the cases of complete paralysis(from Frankel A to Frankel B) and 100% in the cases of incomplete paralysis.[HT5”H]Conclusion [HT5”SS]The merits of this treatment method are as follows:total removal of bony fragments causing the compression around cauda equina and internal fixation performed at the same setting stabilizing the spinal column;chances of recovery of nerve function was provided.The recurrence of secondary spinal injury and complications can be avoided;the decompression was complete and fixation firm.It is an effective method for the treatment of thoracolumbar vertebrae fracture combined with spinal cord injury.更多还原