后路固定器对胸腰椎骨折的间接减压与开放减压比较

The Comparison of the Indirect Decompression with Pedicle Instrument and the Open Decompression to Vertebra Tube on Thoracolumbar Burst Fractures

目的评价胸腰椎爆裂骨折在后路器械固定下对椎管的间接减压与开放减压两种方式的临床疗效,为今后的治疗选择提供依据。方法对我院2003年6月至2004年6月收治的38例胸腰椎爆裂骨折患者随机分为两组:19例行后路暴露,台上复位,椎弓根螺钉内固定术,并将其定义为间接减压组;19例行半椎板或全椎板减压,椎弓根螺钉内固定,半椎板或横突或关节突融合术,定义为开放减压组。观察两组的术中情况及并发症,评判各组的脊柱矫形,椎管占位,复位及ASLA分级情况,各组观察指标采用组间配对t检验进行分析。结果间接减压组的平均手术时间,术中出血量,术后引流量分别为75min,180mL、80mL,而开放减压组为125min、460mL、165mL。椎体前高、后高、cobbe角随访时的丢失率两组分别为:间接减压组2.3%,1.2%,0.5°;开放减压组7.7%、2.6%、3.1°。间接减压组术后椎管平均减压30.2%,开放减压组32.2%。两组术后ASLA分级均有1～2级进步。结论间接减压组较开放减压组具有手术时间短,术中出血少,术后引流量少,脊柱矫正度丢失率低,术后康复快,脊柱稳定性好及无明显并发症的优点,两组在椎管减压程度及ASLA进步方面效果相近。建议对胸腰椎爆裂骨折的治疗在后路器械固定下首选间接减压的方式;少数椎管内碎骨片突入大于50%的患者,在行开放减压的同时,最好通过伤椎椎弓根植骨对伤椎作强化处理,以保证脊柱稳定。

Objective To evaluate their chinical curative effect of the indirect decompression and the open decompression on thoracolumbar burst fractures treated with short-segments pedicle instrument and to supply basis for further treatment choice. Methods We devided the 38 cases of thoracolumbar burst fractures during June 2003 to June 2004 into two groups. nineteen cases were operated with back exposition, reduction and fixed with pedicle screw. We call it the indirect decompression group. Nineteen cases were treated with the operation of back-road half-vertebrac board or full-vertebra board decompression, fixed with pedicle screw and combined with half vertebrac board or intertransverse or zygapophysiales. We call it the open decompression group. To observe the two groups situation during the operation and their complication, then to judge the situation about spinal colume orthopaedic, vertebra tube occupying-place, and ASLA grading. The date were analyzed by paired Sudent′s test. Results In the former group, the average operation time, bleeding amount during the operation, drainage amount after the operation were separately 75 min, 180 mL, 80 mL each. In the latter group, those were 125 min,460 mL,180 mL. In the former group, the losing rate of the front height in vertebra body, the back height in vertebra body, cobbe angle during the following-up was 2.3%, 1.2%, 0.5°. In the latter group, that was 7.7%, 2.6%, 3.1°. The vertebra tube was averagely decompressed 30.2% in the indirect decompression group while that was 32.2% in the open one. ASLA grading was both made progress in one or two grades after the operation. Conclusion The indirect decompression group had more merits than the open one, such as shorter operation time, less bleeding during the operation, less drainage amount after the operation, lower losing-rate of spinal colume orthopaedic, more quickly recovering after operation, good stabilization of spinal column and no obvious complication. The two groups had close effects in vertebra tube degree and ASLA progress. We suggest that the indirect decompression should be first selected to treat with short-segment pedicle instrument on thoracolumbar burst fractures. When some patients whose broken bone moved into vertebra tiube(>50%) were operated with the open decompression in the same time, they had better be treated with transpedicular bone grafting in order to pledge spinal column stabilization.