脊柱后路减压治疗胸腰段骨折脱位合并脊髓损伤术式选择

The surgical choices for posterior decompression in the treatment of thoracolumbar fractures and dislocations with spinal cord injuries

目的研究两种不同脊柱后路减压方法治疗胸腰段骨折脱位合并脊髓损伤的手术治疗效果.方法回顾分析本院1996年3月～2002年6月收治的胸腰段骨折脱位并脊髓损伤患者76例,按不同减压方法将其分为两组:切除一侧或两侧椎板、椎弓根或部分关节突行侧前方环状减压AF内固定者40例,为直接减压组;体位复位结合AF器械矫正复位36例,为间接减压组.统计学分析,两组资料具有可比性.对术后神经功能恢复情况,按ASIA神经功能评定标准进行评定.中晚期并发症,根据是否有腰背痛,下肢根性痛、麻木无力,两便功能障碍进行评定.生活能力按FIM评定.结果两组病例获6个月～5年随访,结果表明,术前脊髓完全性损伤,术后均无恢复;术前脊髓不完全性损伤,术后两组间比较差异无显著性.中晚期并发症发生,直接减压组高于间接减压组;术后生活自理能力,间接减压组好于直接减压组.结论间接减压手术方法治疗胸腰段骨折脱位合并脊髓损伤不失为一种早期治疗的首选方法.

Objective To compare the effects of two surgical methods for posterior decompression on the treatment of thoracolumbar fractures and dislocations with spinal cord injuries. MethodsThrough the retrospective analysis from March 1996 to June 2002, 76 cases of thoracolumbar fractures and dislocations with spinal cord injuries were divided into two groups by different decompression methods: 40 cases who had one-or-two-side laminas, pedicles or parts of articular process cut off with anterolateral annular decompression and AF internal fixation were sorted into the direct decompression group, and 36 cases with postural and AF instrumental reduction were sorted into the indirect decompression group. There was a comparison between the two groups by statistical analysis. The recovery of neurological function after operation was evaluated by ASIA evaluation standard.The complications in medium and late phases were evaluated according to that whether there were low back pain, numbness and asthenia, or dysfunction of defecation and micturition. The living ability was evaluated by FIM. ResultsTwo groups were both followed up for 6 months to 5 years. The results showed the patients with complete spinal cord injuries were not recovered by both of the two surgical methods, and there was no significant difference between the two groups with incomplete spinal cord injuries after the two operations. The incidence rate of complications in medium and late phases of the direct decompression group was higher than that of the indirect decompression group, and independent living ability after operation of the latter was better than that of the former. ConclusionThe surgical method of indirect decompression is the principal choice for the early treatment of thoracolumbar fractures and dislocations with spinal cord injuries