后路器械间接减压固定不做椎间融合与开放减压融合固定治疗胸腰椎骨折的疗效比较

Comparison of therapeutic effects of the indirect decompression by pedicle instrument without interbody fusion and the open decompression to vertebra tube with fusion-stabilization on thoracolumbar burst fractures

目的比较胸腰椎骨折后路器械间接减压固定不做椎间融合与椎管开放减压固定植骨融合两种方法的临床疗效。方法回顾性分析我院1997年5月至2007年5月收治的78例经后路椎弓根钉系统固定的急性胸腰椎骨折患者,分为两组:采用后路器械撑开间接减压不做植骨融合的52例;采用椎管开放减压植骨融合的26例。观察两组的术中情况、并发症和脊柱活动度,评价比较两组的脊椎复位情况、后遗畸形、椎管占位及神经功能恢复情况,进行统计学分析。结果间接减压固定组平均手术时间、术中出血量和术后引流量各为(70±8)min、(130±10)ml和(80±10)ml,椎管开放减压固定植骨融合组分别为(160±15)min、(350±65)ml和(250±10)ml,两组间差异有统计学意义(P<0.01)。椎体的前高、后高、Cobb角的丢失率和丢失角度两组差异有统计学意义(P<0.05)。两组遗留椎管狭窄患者差异有统计学意义(P<0.05)。间接减压固定组断钉率低且脊柱生理运动功能恢复好。两组术后神经功能恢复相近,有神经损伤的除6例Frankel分级A级无改变外其余改善1～2级。结论间接减压固定法较椎管开放减压法手术时间短、术中出血少,术后引流量少、脊柱稳定性好、矫正度丢失率低、并发症少、生理运动功能恢复好而快。

Objective To compare the therapeutic effect of the indirect decompression by pedicle instrument without interbody fusion and the open decompression to vertebra tube with fusion-stabilization on thoracolumbar burst fractures.Methods The 78 cases of acute fracture of thoracolumbar,which fixed with pedicle screw spinal system through posterior approach in our hospital during May 1997 and May 2007 were retrospectively analyzed.All of the patients were devided into two groups:52 cases were treated with the method of the indirect decompression by pedicle instrument without interbody fusion;26 cases were treated with the method of the open decompression to vertebra tube with fusion-stabilization.To observe the situation during the operation,the complications and the spine movement of two groups.To evaluate,compare and analysis the spine replacement,the sequel deformity,the spinal canal encroachment and the functional restoration of the nerve of two groups.Results The average operating time,blood loss during the operation and the postoperative drainage of the indirect decompression group were(70±8)min,(130±10)ml and(80±10)ml respectively,while those of the open decompression to vertebra tube with fusion-stabilization were(160±15)min,(350±65)ml and(250±10)ml respectively.There were statistically significant differences in the results between the two groups(P<0.01).There were also statistically significant differences in the anterior heights,posterior heights of the vertebral body and the loss rate,loss of correction of the Cobb angle between the two groups.There were also statistically significant differences in spinal stenosis left between the two groups.The plate breaking rate was lower and the physiological activities and functions recover were better in the indirect decompression group.The effect of post-operation neural functional recovery of the two groups were similar.In all of the patients who suffered the nerve injury,according to the standard of FRANKEL,except 6 cases of grade A didn't show any improvement,the others had one or two grade improvement in the nerve function.Conclusions Compared to the open decompression to vertebra tube method,the indirect decompression stabilization method can obtain shorter operating time,less blood loss,less postoperative drainage,better stabilization of the spine,lower loss rate of correction of the Cobb angle,less complications and better and faster physiological activities and functions recover.