经椎间孔椎间植骨治疗胸腰段骨折脱位的临床及影像学研究

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摘要目的本文拟评价经椎间孔椎间融合治疗胸腰段骨折的临床疗效及影像学情况。方法将我院2010至2013年收治的42例，完成2年随访的38例经椎间孔植骨融合治疗的胸腰段骨折脱位患者进行前瞻性临床及影像学评估，其中男性24例，女性14例，手术时间为受伤后17.6 h(11～23 h)，临床结果通过美国脊柱损伤协会(Amenican spinal injury association，ASIA)运动与感觉评分，影像学结果通过X线片及CT三维重建对减压范围、椎间植骨融合进行评估，并对其围手术期并发症进行评估。结果所有患者均成功完成手术，平均手术时间为(170±30)min，手术出血(820±110)mL，随访2年ASIA感觉评分、运动评分分别从术前的(77.9±12.2)分、(70.5±7.2)分提高到(90.5±11.8)分、(83.5±9.1)分，椎管占位从术前的(72.8±4.5)％降低到(4.0±2.1)％，与术前比较差异有统计学意义(P＜0.05)，三维CT提示所有患者椎间植骨融合，未见内固定失败病例。围手术期出现脑脊液漏5例，未出现伤口感染等并发症。结论经椎间孔植骨融合治疗胸腰段骨折脱位只需要后路就能够达到环脊髓减压，重建脊柱稳定性，术后临床症状恢复良好，手术安全，围手术期并发症少。

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关键词 ：经椎间孔植骨融合, 胸腰段骨折脱位, 环脊髓减压, 神经症状恢复, 手术并发症

Abstract：Objective To explore the clinical effect of transforaminal thoracic interbody fusion (TTIF) for the treatment of thoracolumbar fracture-dislocations.Methods 42 consecutive patients with thoracolumbar fracture-dislocations underwent TTIF in our institution but four patients could not be followed up.Radiographs and computed tomography (CT) data was prospective examined and compared.The clinical outcome was measured in terms of the American Spinal Injury Association (ASIA) score，perioperative complications related to operation.Results These 38 patients include 24males and 14 females，with an average age of (39.4±9.7) years.The mean duration between injury and surgery was 17.6 (11～23) hours of the 38 patients，all operative procedure was successfully.There were 5 cerebral spinal fluid leakages.The mean operative time was (170±30)min.The blood loss was (820±110)mL，the mean ASIA sensory score was (77.9±12.2) and (90.5±11.8).The average ASIA motor score was (70.5±7.2) and (83.5±9.1) before surgery and at the final follow-up，respectively.The spinal canal narrowing decreased from (72.8±4.5)％ before surgery to 4.0±2.1)％ at the final follow-up，the solid fusion rate was 100％.There was radiological sign of instrumentation failure at the final follow-up.Conclusion Our findings suggest that TTIF allows for safe interbody fusion and circumferential decompression，requires only a posterior approach，and is associated with a lower incidence of surgery-related complications.

Key words： transforaminal interbody fusion thoracolumbar fracture-dislocation circumferential decompression neural recovery surgery related complications

基金资助:陕西省社发攻关基金(2013K12-14-01)
西安市红会医院科研基金资助课题(YJ2012002)

通讯作者: 刘继军

作者简介: 王文涛(1982－)，男，主治医师，西安交通大学医学部附属西安红会医院脊柱科，710061。

引用本文:

王文涛 1，段琨 2，王欣文 1，刘团江 1，吴起宁 1，郝定均 1，刘继军 1*. 经椎间孔椎间植骨治疗胸腰段骨折脱位的临床及影像学研究[J]. 实用骨科杂志, 2017, 23(4): 297-300.
Wang Wentao1，Duan Kun2，Wang Xinwen1，et al. Clinical and Radiological Outcome of Transforaminal Thoracic Interbody Fusion for Thoracolumbar Fracture-dislocations. sygkzz, 2017, 23(4): 297-300.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I4/297

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