Li Hong-jie, Zhang Wen-bin, Fang Chun-yang, Mo Ting-ting
Department of Spinal Surgery, Wenling Hospital Affiliated to Wenzhou Medical University, Zhejiang, China.
Zhongguo Gu Shang. 2014 Nov;27(11):928-32.
To compare the clinical outcome between posterior corpectomy, decompression and reconstruction and combined anterior-posterior surgery in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia, and to provide a basis for procedure selection.
Clinical and radiographic results of posterior corpectomy, decompression and reconstruction (group A) and combined anterior-posterior surgery (group B) in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia were analyzed retrospectively from January 2008 to December 2012. In group A, there were 18 patients (10 males and 8 females). The fractures were located on T11 in 1 case, T12 in 5 cases, L1 in 6 cases and L2 in 6 cases. In group B, there were 15 patients (9 males and 6 females). The fractures were located on T1 in 1 case, T12 in 5 cases, L1 in 5 cases and L2 in 4 cases. Neurological status was judged by Frankel grades. The X-ray and CT were used for evaluation of the restoration of anterior height of the fractured vertebral body, the correction of Cobbs angle, the decompression scope of spinal canal and the fusion. Complications related to operation were also considered. Results: The followup periods ranged from 12 to 18 months (averaged 16 months). The mean operation time, perioperative bleeding, postoperative drainage were (200 ± 43) min, (1100 ± 344) ml, and (400 ± 112) ml respectively in group A; and (290 ± 68) min, (1 500 ± 489) ml, (900 ± 269) ml respectively in group B. There was statistically significant difference between groups A and B (P < 0.05). There were significant improvements in anterior height of fractured vertebral body and Cobbs angle after operation. But there was no significant difference between groups A and B (P > 0.05). In Frankel grades, all patients had one grade or more improvement postoperatively. There was no significant difference between two groups (P > 0.05).
Treatment of thoracolumbar vertebra burst fractures with subtotal vertebrectomy, decompression and reconstruction of anterior column through posterior approach has a similar clinical result compared to the operation through combined anterior and posterior approach, but the posterior surgery decreased surgical trauma. It is an effective and safe surgical method.
比较后路椎体次全切除减压重建术与前后联合手术治疗重度胸腰椎三柱骨折伴不全截瘫的临床疗效，为术式选择提供依据。
回顾性分析2008年1月至2012年12月采用后路椎体次全切除减压重建术（A组）和前后联合手术（B组）治疗重度胸腰椎三柱骨折伴不全截瘫的临床及影像学结果。A组18例，男10例，女8例，骨折部位：T11 1例，T12 5例，L1 6例，L2 6例；B组15例，男9例，女6例，骨折部位：T1 1例，T12 5例，L1 5例，L2 4例。采用Frankel分级判断神经功能状态，通过X线、CT评估伤椎前缘高度恢复、Cobb角矫正、椎管减压范围及融合情况，并观察手术相关并发症。结果：随访时间12～18个月，平均16个月。A组平均手术时间、术中出血量、术后引流量分别为（200±43）min、（1100±344）ml、（400±il2）ml；B组分别为（290±68）min、（1500±489）ml、（900±269）ml，A、B两组比较差异有统计学意义（P<0.05）。两组术后伤椎前缘高度及Cobb角均有明显改善，但组间比较差异无统计学意义（P>0.05）。Frankel分级显示，两组患者术后均有1级或以上改善，组间比较差异无统计学意义（P>0.05）。
后路椎体次全切除减压重建术治疗胸腰椎爆裂骨折与前后联合手术临床疗效相似，但后路手术创伤小，是一种安全有效的手术方法。
