前后联合入路行侧卧位椎弓根钉植入在脊柱外科手术中的应用可行性(1)
【摘要】 目的：探究前后联合入路行侧卧位椎弓根钉植入在脊柱外科手术中的临床应用效果以及可行性。方法：选取本院收治的30例严重胸腰椎爆裂骨折患者，采用前后联合入路行侧卧位椎弓根钉植入手术。比较患者手术前后各项指标的变化情况。结果：对患者定期随访12～24个月。手术前影像学检查发现，患者椎管容积占位率平均为(48.15±5.21)%，Cobb角平均(34.3±2.8)°，伤椎前缘高度(56.16±11.67)%，在术后及最后一次随访各项指标均恢复到满意效果，椎管内占位骨块基本全部切除，Cobb角平均恢复(3.4±1.1)°，伤椎前缘高度在手术后立即检测时升高，但最后一次随访时有所下降；在ASIA分级变化情况方面，只有1例分级为A级的患者神经功能没有恢复，其余患者神经功能均恢复了1～2级。结论：前后联合入路行侧卧位椎弓根钉植入在治疗严重胸腰椎爆裂骨折方面可以获得满意效果，值得临床推广。
【关键词】 前后联合入路； 侧卧位； 胸腰椎骨折； 椎弓根钉
The Feasibility Analysis of the Anteroposterior Approach with Patient Lying in the Lateral Position with the Pedicle Screw Implantation in the Spine Surgery/HUANG Jie-yuan，MO Xiong，GUO Wei-tao.//Medical Innovation of China，2015，12(18)：029-031
, http://www.100md.com
【Abstract】 Objective：To explore the clinical effect and feasibility analysis of the anteroposterior approach with the patient lying in the lateral position with the pedicle screw implantation in the spine surgery.Method：30 cases were chosen，approached with the patients lying in the lateral position with the pedicle screw implantation.Patients were regularly followed up and visited.The changes of every indicator of patients’ bodies were compared.Result：All cases were followed up for 12 to 24 months.The average spinal canal occupation ratio was (48.15±5.21)% and the average segental Cobb angle was(34.3±2.8)°，the average anterior vertebral height was (56.16±11.67)%.But in the last time follow-up after surgery，the indicators which were examined were restored and achieved to a satisfactory results.After resection of the vertebral body，the average segmental Cobbangle was(3.4±1.1)° post-operatively，and neurology function was restored 1-2 grades in 29 cases except 1 case was not restored defined by ASIA criteria.Conclusion：Treatment of thoracolumbar burst fracture by ananteroposterior approach with the patient lying in the lateral position can result in good clinical effectiveness and it is worth promoting in the clinic.
, http://www.100md.com
【Key words】 Anteroposterior approach； Lateral position； Thoracolumbar fracture； Pedicle screw
First-author’s address：The People’s Hospital of Leizhou City，Leizhou 524200，China
doi：10.3969/j.issn.1674-4985.2015.18.010
胸腰椎爆裂性骨折是一种常见的骨折，产生原因包括外部力的方向、力的能量大小以及每个人脊柱特殊的内部结构。而胸椎和腰椎两者之间的衔接点就是胸腰椎，由于胸椎的活动较少而腰椎的活动较多，所以稍微受到外力的撞击就会因为胸腰椎所受的应力集中而产生伤害，造成椎体中柱向椎管内部进行移位，从而使得椎管容积缩小[1]。近年来，随着交通车辆的日益增多和建筑业的迅速发展，进而造成严重胸腰椎爆裂骨折的患者也日渐增多，甚至伤及脊柱前、中、后三柱，形成不稳定的骨折，进而也会造成脊髓不同程度的损伤[2-4]。对患者以及家庭会带了沉重的伤害以及负担。目前对胸腰椎骨折主要的治疗方式为手术，而手术方式主要有三种，其中包括通过前路进行椎管减压进而对脊柱的稳定性进行重建，还有单纯后路方式以及前后联合入路的手术方式。所以，选取一个有效而适合的治疗方法对患者的治疗包括减少并发症的发生，有着重要而深刻的意义。本文选取了2013年8月-2014年12月本院收治的30例严重胸腰椎爆裂骨折患者，对患者进行前后入路的手术方式，均采用侧卧位，即先进行后路的椎板减压，用椎弓根钉内固定使后路撑开进而恢复脊柱的序列，然后保持同一体位，进而同时在前路进行椎体次全切、椎管减压以及植骨的融合，使得三柱得到固定。并且对这种手术方式在临床上的治疗效果以及应用可行性进行观察分析。, http://www.100md.com(黄解元 莫雄 郭伟韬)
【关键词】 前后联合入路； 侧卧位； 胸腰椎骨折； 椎弓根钉
The Feasibility Analysis of the Anteroposterior Approach with Patient Lying in the Lateral Position with the Pedicle Screw Implantation in the Spine Surgery/HUANG Jie-yuan，MO Xiong，GUO Wei-tao.//Medical Innovation of China，2015，12(18)：029-031
, http://www.100md.com
【Abstract】 Objective：To explore the clinical effect and feasibility analysis of the anteroposterior approach with the patient lying in the lateral position with the pedicle screw implantation in the spine surgery.Method：30 cases were chosen，approached with the patients lying in the lateral position with the pedicle screw implantation.Patients were regularly followed up and visited.The changes of every indicator of patients’ bodies were compared.Result：All cases were followed up for 12 to 24 months.The average spinal canal occupation ratio was (48.15±5.21)% and the average segental Cobb angle was(34.3±2.8)°，the average anterior vertebral height was (56.16±11.67)%.But in the last time follow-up after surgery，the indicators which were examined were restored and achieved to a satisfactory results.After resection of the vertebral body，the average segmental Cobbangle was(3.4±1.1)° post-operatively，and neurology function was restored 1-2 grades in 29 cases except 1 case was not restored defined by ASIA criteria.Conclusion：Treatment of thoracolumbar burst fracture by ananteroposterior approach with the patient lying in the lateral position can result in good clinical effectiveness and it is worth promoting in the clinic.
, http://www.100md.com
【Key words】 Anteroposterior approach； Lateral position； Thoracolumbar fracture； Pedicle screw
First-author’s address：The People’s Hospital of Leizhou City，Leizhou 524200，China
doi：10.3969/j.issn.1674-4985.2015.18.010
胸腰椎爆裂性骨折是一种常见的骨折，产生原因包括外部力的方向、力的能量大小以及每个人脊柱特殊的内部结构。而胸椎和腰椎两者之间的衔接点就是胸腰椎，由于胸椎的活动较少而腰椎的活动较多，所以稍微受到外力的撞击就会因为胸腰椎所受的应力集中而产生伤害，造成椎体中柱向椎管内部进行移位，从而使得椎管容积缩小[1]。近年来，随着交通车辆的日益增多和建筑业的迅速发展，进而造成严重胸腰椎爆裂骨折的患者也日渐增多，甚至伤及脊柱前、中、后三柱，形成不稳定的骨折，进而也会造成脊髓不同程度的损伤[2-4]。对患者以及家庭会带了沉重的伤害以及负担。目前对胸腰椎骨折主要的治疗方式为手术，而手术方式主要有三种，其中包括通过前路进行椎管减压进而对脊柱的稳定性进行重建，还有单纯后路方式以及前后联合入路的手术方式。所以，选取一个有效而适合的治疗方法对患者的治疗包括减少并发症的发生，有着重要而深刻的意义。本文选取了2013年8月-2014年12月本院收治的30例严重胸腰椎爆裂骨折患者，对患者进行前后入路的手术方式，均采用侧卧位，即先进行后路的椎板减压，用椎弓根钉内固定使后路撑开进而恢复脊柱的序列，然后保持同一体位，进而同时在前路进行椎体次全切、椎管减压以及植骨的融合，使得三柱得到固定。并且对这种手术方式在临床上的治疗效果以及应用可行性进行观察分析。, http://www.100md.com(黄解元 莫雄 郭伟韬)