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1、早期后路手术治疗胸腰椎爆裂性骨折刘彬宋留红刘德祥岳思阳(彭州市人民医院骨科611930)【摘要】目的探讨早期后路手术对胸腰椎爆裂性骨折的治疗价值,以达到最大的椎管后凸骨块的复位，恢复脊椎序列，减少椎管狭窄，增加脊椎的稳定性。方法采用后路间接椎管扩大、短节段椎弓根螺钉固定技术，对48例(无神经症状36例，有神经症状12例)胸腰椎爆裂性骨折进行手术治疗的患者进行回顾分析，依据术中c臂观察椎管内骨块复位情况，决定是否后路椎板减压。非减压组40例，减压组8例，减压后行横突间植骨/+单侧椎板后植骨。有神经损伤12例,无神经伤36例。结果48例中无神经
2、损伤36例均未行椎管减压，椎管侵入(37.16±15.15)%;合并神经损伤12例,椎管侵入(48.59±16.89}%,，4例未行椎管减压,8例行椎管减压，两组差异显著(P<0.05}。非减压组(40例)和减压组(8例)术前侵入椎管比例分别为(41.97±12.90)%、(43.52±16.15)%(P>0.05)o治疗后非减压组和减压组侵入椎管比例分别为(20.69±15.93)%、(27.37±12.89)%,非减压组椎管矢状径平均改善23
3、.28%,减压组为14.15%(P<0.05),神经损伤症状均有明显改善。结论胸腰椎爆裂性骨折引起的椎管狭窄程度与祌经损伤密切相关，术中根据c臂观察椎管内骨块后凸复位情况决定是否行椎管减压，早期后路手术能大部分改善胸腰椎爆裂性骨折椎管狭窄程度，多数不需要后路减压，减少对脊椎后柱的破坏。【关键词】胸腰椎爆裂性骨折手术治疗【中图分类号】R687【文献标识码】A【文章编号】2095-1752(2013)33-0109-03[Abstract]Objective：Toexplorethetherapeuticvalueofposterioro
4、perationearlyburstfracturesofthoracolumbar,reductiontoachievemaximumcanalskeletonblock,restorevertebralsequence,reducespinalstenosis,increasethestabilityofspine.Methods:usingindirectspinalcanal,posteriorshort-segmentpediclescrewfixation,48cases(36caseswithoutneurologicalsy
5、mptoms,neurologicalsymptomsin12cases)ofthoracolumbarburstfractureswereretrospectivelyanalyzedpatientsunderwentoperationtreatment,basedontheintraspinalbonereductionwereobservedinCarm,decidewhetherposteriordecompression.Nondecompressiongroup40cases,decompressiongroup8cases,b
6、onegraftafterdecompressionintertransverse/+afterlaminectomy.Thereare12casesofnerveinjury,nonerveinjuryin36cases.Results:therewasnonerveinjuryin36caseswerenotdecompressionofspinalcanalin48cases,invasive(37.16±15.15)%;12casescomplicatedwithnerveinjury,spinalcanalintru
7、sion(48.59±16.89)%”4caseswithoutspinalcanaldecompression,8casesofspinalcanaldecompression,twogroupshadsignificantdifference(P<0.05).Nondecompressiongroup(40cases)anddecompressiongroup(8cases)preoperativevertebralcanalrespectively(41.97±12.90)%,(43.52&plusm
8、n;16.15)%(P>0.05).Afterthetreatmentofnondecompressionofvertebralcanaldecompressiongrou
