两种不同手术入路减压复位融合内固定治疗颈椎骨折脱位合并脊髓损伤的疗效比较

Comparison of Two Different Surgical Approaches of Decompression Reduction and Fusion Internal Fixation in the Treatment of Cervical Spine Fractures and Dislocations Combined with Spinal Cord Injury

目的比较两种不同手术入路减压复位融合内固定术治疗颈椎骨折脱位合并脊髓损伤的效果。方法选择2020年2月—2022年1月中国人民解放军联勤保障部队第九二四医院收治的颈椎骨折脱位合并脊髓损伤患者45例,随机分为对照组22例和观察组23例。对照组采用后路减压复位融合内固定术,观察组采用前路减压复位融合内固定术,比较两组患者术后恢复情况。结果两组手术时间、住院时间、术中出血量、术后引流量比较,差异有统计学意义(P<0.05)。两组术后Cobb角、椎体间滑移距离和JOA评分比较,差异有统计学意义(P<0.05)。两组术后椎体总融合率和椎体融合时间比较,差异有统计学意义(P<0.05)。两术后颈脊髓神经功能优良率比较,差异有统计学意义(P<0.05)。结论相比于后路减压复位融合内固定术,前路减压复位融合内固定术在治疗颈椎骨折脱位合并脊髓损伤患者中效果显著,能对患者椎体功能进行改善,对脊髓神经功能恢复起促进作用,且安全性较高。

Objective To compare the effects of two different surgical approaches of decompression reduction and fusion internal fixation in the treatment of cervical spine fractures and dislocations combined with spinal cord injury.Methods From February 2020 to January 2022,45 patients with cervical spine fracture and dislocation combined with spinal cord injury admitted to our hospital were randomly divided into the control group(n=22 cases)and the observation group(n=23 cases.)The control group received posterior decompression reduction and fusion internal fixation,while the observation group received anterior decompression reduction and fusion internal fixation.The two groups were followed up for 9 months to compare their postoperative recovery.Results There were significant differences between the two groups in operative time,hospital stay,intraoperative bleeding,and postoperative drainage volume(P<0.05).There were significant differences in Cobb angle,intervertebral slip distance,and JOA scores after surgery between the two groups(P<0.05).There was a significant difference in the time of vertebral fusion after surgery between the two groups(P<0.05).There was a significant difference in the excellent and good rate of cervical spinal cord nerve function between the two operations(P<0.05).Conclusion Compared with posterior decompression reduction and fusion internal fixation,anterior decompression reduction and fusion internal fixation has a significant effect in the treatment of patients with cervical spine fracture and dislocation combined with spinal cord injury.It can improve the vertebral body function of patients,promote the recovery of spinal cord nerve function,and has high safety.