胸腰段脊柱爆裂骨折前路与后路手术疗效对比观察

Treatment of unstable thoracolumbar burst fractures： a comparison between anterior approach and posterior approach

目的对胸腰椎爆裂骨折行前路手术和后路手术的患者进行回顾性研究，客观评价不同手术入路治疗后的影像学结果，为胸腰椎爆裂骨折的外科治疗提供可靠的参考。方法筛选2003年1月-2005年12月收治的41例胸腰椎爆裂骨折患者作为研究对象，随访24～48个月，平均38个月。按照手术入路分为前路手术和后路手术两组。根据随访X线侧位片测量Cobb角作为效果评价标准，并进行统计学分析。结果前路手术组共19例，入院时平均Cobb角为27．3°，术后为3．1°，随访结束时为4．6°；后路手术组共22例，入院时平均Cobb角为26．1°，术后为3．0°，随访结束时为12．5°。两组患者术前和术后即刻Cobb角差异无统计学意义（P〉0．05），但随访结束时两者差异有统计学意义（P〈0．01）。结论前路手术对于改善和维持胸腰椎爆裂骨折后凸角度优于后路手术。

Objective To retrospectively analyse the anterior and posterior surgical approaches in treatment of unstable burst thoracolumbar fractures and compare radiographic measurement parameters of both surgical techniques so as to provide references for surgical treatment of such kind of fracture. Methods The study selected 41 patients with unstable thoracolumbar fracture treated with either anterior neurodecompression and fixation （n = 19） or posterior reposition and internal fixation by pedicle screw （ n =22） from January 2003 to December 2005. All patients were followed up for 2448 months （ mean 38 months） and divided into anterior approach group and posterior approach group. Sagittal alignment was assessed by the Cobb angle depending on lateral radiographs. Results The Cobb angle of the anterior approach group was average 27.3° on admission but 3.1° postoperatively and 4.6° at follow-up; while the Cobb angle of posterior approach was average 26.1° on admission, 3.0°postoperatively and 12.5°at follow-up. There was no statistical difference between Cobb angle on admission and postoperative one （P 〉 0.05） but showed significant differences between them at follow-up （P 〈 0.01 ）. Conclusion The anterior surgical approach can consistently yield better maintenance of kyphotic correction compared with the posterior surgical approach.