干旱区生态环境知识资源中心(Arid): 陈旧性胸腰椎骨折并脊髓损伤的后路手术治疗

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	陈旧性胸腰椎骨折并脊髓损伤的后路手术治疗
其他题名	Surgical treatment by posterior approach for old thoracolumbar fractures with spinal cord injury
	孙天胜; 刘树清; 刘智; 李放; 关凯; 胥少汀
来源期刊	中华骨科杂志
ISSN	0253-2352
出版年	2003
卷号	23 期号:10 页码:581-585
中文摘要	目的探讨陈旧性胸腰椎骨折并脊髓损伤的后路手术方法和临床治疗效果。方法 69例陈旧性胸腰椎骨折并脊髓损伤患者，年龄15～75岁，平均35.6岁。受伤至本次手术时间3个月～11年，平均25个月。患者均存在脊髓前方压迫及后凸畸形，并有不同程度的脊髓损伤。其中10例后凸角>20°，平均35°(21°～75°)；59例后凸角<20°，平均9°(0°～16°)，以后凸角的大小作为选择手术方式的标准，对后凸角<20°者行后路椎管侧前方减压术，对后凸角>20°者行后路经椎弓根椎体楔形截骨术。结果术后随访10个月～6年，平均12.5个月，59例(85.5%)患者获得满意的减压。10例行后路经椎弓根椎体楔形截骨的患者获得满意的后凸畸形矫正，术后后凸角平均10.8°(0°～40°)。44例(63.8%)患者神经功能得到不同程度的恢复，全瘫患者的恢复率为17.6%，主要是感觉功能恢复，而不全瘫患者的恢复率为78.8%，感觉和运动功能都有所恢复，两者之间差异有非常显著性意义(P<0.01)。结论对陈旧性胸腰椎骨折并脊髓损伤患者可以根据其后凸角大小选择经后路椎管侧前方减压术或经椎弓根椎体楔形截骨术。术后患者可获得满意的减压和后凸畸形矫正，神经功能有不同程度的恢复。
英文摘要	Objective To evaluate the surgical technique and its outcomes by posterior approach for old thoracolumbar fractures with spinal cord injury. Methods 69 oases of old thoracolumbar fractures with spinal cord injury, aging from 15 to 57 years with an average of 35.6 years, were recruited in this study. The mean time from injury to the index operation was 25 months ranging from 3 months to 11 years. The fracture location consisted of T_(11) in 3, T_(12) in L_1 in 45 and L_2 in 8. Prior to the index surgery, 22 patients received conservative treatment, and 47 patients underwent laminectomy with internal fixation using Harrington rod in 8, Luque rod in 15, pedicles screws in 10 and spinous process immobilization in 8. The common character-istics of the patients were anterior compression to spinal cord, kyphotic deformity, and complicated with neurological dysfunction caused by spinal cord injuries. There were complete paraplegia in 17 cases and in-complete paraplegia in 52 cases. The patients were found with remained kyphotic deformity of a mean 28°, in which 10 cases>20°, ranging from 21° to 75°(average, 35°), and 59 cases <20°, ranging from 0° to 16° (average, 9°). According to the deformity angles, transpedicular anterior decompression was performed in cases of <20°, and transpedicular osteotomy for those of >20°. Results Successful decompression in which the distance from the middle point of connecting line between bilateral transverse processes to the posterior wall of vertebral body was more than 8 mm, was achieved in 59 cases (85.5%); satisfied correction of kypho-sis was noticed in 10 cases. Post-operatively the mean angle of kyphosis deformity was 10.8° ranging from 0° to 40°. During the mean follow-up period of 12.5 months, neurological functional recovery was noticed in 63.8% of total cases. For complete spinal cord injury, 17.6% of cases recovered partially (sensory function), whereas neurological function recovery was noted in 78.8% of cases with incomplete spinal cord injury, the statistical difference was significant between the incomplete and complete spinal cord injury cases. Conclu-sion The old thoracolumbar fracture with incomplete spinal cord injury could be treated with transpedicular anterior decompression and osteotomy, neurological functional recovery is expected.
中文关键词	胸椎 ; 腰椎 ; 脊髓损伤 ; 骨科手术方法 ; 治疗结果
英文关键词	thoracic vertebrae lumbar vertebrae spinal cord injuries orthopedic procedures treatment outcome
语种	中文
国家	中国
收录类别	CSCD
WOS类目	SURGERY
WOS研究方向	Surgery
CSCD记录号	CSCD:1259836
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/204721
作者单位	北京军区总医院骨科, 100700
推荐引用方式 GB/T 7714	孙天胜,刘树清,刘智,等. 陈旧性胸腰椎骨折并脊髓损伤的后路手术治疗[J],2003,23(10):581-585.
APA	孙天胜,刘树清,刘智,李放,关凯,&胥少汀.(2003).陈旧性胸腰椎骨折并脊髓损伤的后路手术治疗.中华骨科杂志,23(10),581-585.
MLA	孙天胜,et al."陈旧性胸腰椎骨折并脊髓损伤的后路手术治疗".中华骨科杂志 23.10(2003):581-585.