Schmidek H H, Gomes F B, Seligson D, McSherry J W
Neurosurgery. 1980 Jul;7(1):30-5. doi: 10.1227/00006123-198007000-00005.
A one-stage anterilateral decompression of the thoracolumbar spine with Harrington rod alignment and posterior fusion has proven to be an excellent approach to the management of unstable fractures between T-11 and L-1. Twenty-six cases are reported in which this tactic was used to decompress neural structures and stabilize the spine. Preoperative computed tomographic scanning and somatosensory evoked responses (SSERs) are useful adjuncts in the patient's assessment. Intraoperative SSER studies have allowed monitoring to prevent an increase in the patient's neural deficit during operation. Intraoperative myelography is used to provide objective confirmation of the adequacy of the decompression of the spinal subarachnoid space. Satisfactory stability was achieved in all 26 cases reported in this series. Eight of 11 patients with partial neurological deficits returned to essentially normal function within 6 months. None of the patients who were neurologically intact (6 cases) or who had incomplete lesions (11 cases) was made worse by the operation. None of the 9 paraplegic patients regained spinal cord function, although a dramatic improvement in the function of the L-2 and L-3 roots occurred in 1 case. This approach to the management of unstable thoracolumbar fractures is useful, carries with it a low complication rate, and should be a standard part of the neurosurgical and orthopedic armamentarium.
采用哈灵顿棒矫正及后路融合的胸腰椎一期前路减压术已被证明是治疗T11至L1节段不稳定骨折的一种极佳方法。本文报告了26例采用该方法减压神经结构并稳定脊柱的病例。术前计算机断层扫描和体感诱发电位（SSERs）对患者评估很有帮助。术中SSER研究可用于监测，以防止手术期间患者神经功能缺损增加。术中脊髓造影用于客观确认脊髓蛛网膜下腔减压是否充分。本系列报告的所有26例患者均获得了满意的稳定性。11例部分神经功能缺损患者中有8例在6个月内基本恢复正常功能。神经功能完整的6例患者和不完全损伤的11例患者中，无一例因手术而病情加重。9例截瘫患者均未恢复脊髓功能，不过有1例患者L2和L3神经根功能有显著改善。这种治疗不稳定胸腰椎骨折的方法很有用，并发症发生率低，应成为神经外科和骨科治疗手段的标准组成部分。
