后路单侧侧前方椎体次全切除钛网重建椎体治疗高原胸腰椎爆裂骨折

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1、后路单侧侧前方椎体次全切除钛网重建椎体治疗高原胸腰椎爆裂骨折作者：殷作明，林秀来，李素芝，熊国忠，汤建林，刘建伟【摘要】目的探索创伤小、脊髓减压彻底、术后脊柱三柱即刻稳定、患者可早期活动的治疗高原胸腰椎爆裂性骨折的手术方案。方法42例高原胸腰椎爆裂骨折患者，经后路单侧行椎体次全切除、脊髓环形减压、钛网支撑植骨重建前中柱及椎弓根钉后柱内固定。采用美国脊柱损伤学会(ASIA)分级进行神经功能评估，通过X线及CT片评估骨折复位、减压及骨融合情况。结果手术均顺利完成，平均手术时间2.7小时;平均出血量740ml。术后发生脑脊液漏3例，无其它严重并发症发生。随访患者

2、植骨融合，内固定无松动、断裂，椎体的高度、曲度和椎管容积无明显丢失。除A级患者外，其它各级患者神经功能均有不同程度的恢复。结论后路单侧椎体减压重建脊柱三柱稳定性手术具有创伤小、脊髓减压彻底、脊柱前中后柱即刻稳定等特点，可有效恢复椎体高度、脊柱的生理曲度、椎管容积和脊柱即刻稳定性，是治疗高原胸腰椎爆裂骨折的理想手术方式。【关键词】胸腰椎骨折;椎体切除;高海拔　　Abstract：ObjectiveToexploreanoperationmethodwithlessinjury,thoroughspinalcorddecompression,promptpos

3、t11operativethreecolumnstabilityofspineandearlymovementforpatientswiththoracolumbarburstfracturesinhighaltitude.MethodsTotally42patientswiththoracolumbarburstfracturesinhighaltitudeacceptedposteriorunilateralsubtotalcorpectomy,annulardecompressionofspinalcord,titaniummeshbonegra

4、ftforreconstructionofanteriorandmiddlecolumncombinedwithpedicleinstrumentsfixation.SpinalcordinjurywasevaluatedwithASIAgradecriterion.Reduction,decompressionandfusionoffractureswereevaluatedthroughXrayandcomputertomography.ResultsAlloperationswerecompletedsuccessfully.Themeanoper

5、ationtimewas2.7hoursandthemeanbloodlosswas740ml.Cerebrospinalfluidleakageoccurredin3patients.Nootherseverecomplicationswereobserved.Bonegraftfusionwasobservedinfollowuppatients.Noloosenessandruptureofinternalfixation,noobviouslossofvertebralheight,spinalradianandvertebralcanalvol

6、umewereobserved.NervousfunctionimprovedindifferentdegreeinallpatientsexceptthosewhohadthenervousfunctionofgradeA.ConclusionTheoperationofposteriorunilateralsubtotalcorpectomyandreconstructionofspinalthreecolumnstabilityhastheadvantagesoflessinjury,thoroughspinalcorddecompression,

7、promptpost11operativethreecolumnstabilityofspine,andcaneffectivelyrestorevertebralheight,vertebralcanalvolume,physiologicalradianandpromptstabilityofspine.Itisanidealoperationmethodforthetreatmentofthoracolumbarburstfracturesinhighaltitude.　　Keywords：thoracolumbarvertebrafractur

8、e;vertebrectomy;highaltitude　　由于交