Shamhoot Ebrahim Ahmed, Elkholy Ahmed Rizk
Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Egypt.
Asian J Neurosurg. 2019 Apr-Jun;14(2):467-472. doi: 10.4103/ajns.AJNS_262_18.
Combined posterior and anterolateral retroperitoneal approach is very important for the treatment of unstable burst lumber fractures with retropulsed fragments.
The aim of the study is to evaluate the role of combined posterior and anterolateral retroperitoneal approach in the treatment of unstable burst lumber fractures.
This is a retrospective clinical case series study.
This study was conducted on 41 patients with unstable lumber burst fractures with retropulsed fragment. Frankel scale score and Denis pain score were used to evaluate the functional outcome. All patients were surgically treated using combined posterior and anterolateral retroperitoneal approach. They were followed for 1 year postoperatively.
Using SPSS version 21, data were presented as mean ± standard deviation, and percentage and paired sample and Wilcoxon signed-rank tests were used for data analysis.
the functional state of all patients improved after surgery. According to the Frankel and Denis pain scores, there was a significant improvement in patients' scores postoperatively compared to preoperative ones ( = 0.001). Visceral manifestations were present in 16 cases (36.6%) with complete improvement postoperatively except two cases. There is a significant improvement as regards pre- and postoperative regional kyphotic angle (9.12 ± 10.03) and vertebral body height (3.14 ± 0.37). Unintended durotomy occurred in six cases treated by stitching using absorbable sutures and fat graft. Wound infection was present in two cases treated by antibiotics and daily dressing. A solid fusion was achieved in all cases.
Combined posterior and anterolateral retroperitoneal approach is feasible and effective in surgical exposure and treatment of unstable burst lumber fractures with retropulsed fragments.
后外侧与腹膜后联合入路对于治疗伴有骨折块后凸的不稳定腰椎爆裂骨折非常重要。
本研究旨在评估后外侧与腹膜后联合入路在治疗不稳定腰椎爆裂骨折中的作用。
这是一项回顾性临床病例系列研究。
本研究对41例伴有骨折块后凸的不稳定腰椎爆裂骨折患者进行。采用Frankel分级评分和Denis疼痛评分评估功能结果。所有患者均采用后外侧与腹膜后联合入路进行手术治疗。术后随访1年。
使用SPSS 21版，数据以均数±标准差表示，采用百分比、配对样本和Wilcoxon符号秩检验进行数据分析。
所有患者术后功能状态均有改善。根据Frankel和Denis疼痛评分，与术前相比，患者术后评分有显著改善（P = 0.001）。16例（36.6%）出现内脏表现，除2例患者外，术后均完全改善。术前和术后局部后凸角（9.12±10.03）和椎体高度（3.14±0.37）有显著改善。6例患者在使用可吸收缝线缝合和脂肪移植治疗时发生意外硬脊膜切开。2例患者经抗生素治疗和每日换药出现伤口感染。所有病例均实现了牢固融合。
后外侧与腹膜后联合入路在手术显露和治疗伴有骨折块后凸的不稳定腰椎爆裂骨折方面是可行且有效的。
