胸腰椎骨折前后路手术治疗比较

Comparison Between Anterior and Posterior Surgical Treatments of Thoracolumbar Fractures

目的探讨胸腰椎骨折前后路手术治疗的临床效果。方法1998-03/2007-10收治并有随访资料的胸腰椎骨折73例,伴有神经损害者39例,神经功能按Frankel分级评定:A级3例,B级12例,C级16例,D级8例。根据伤情选择前路手术31例,选择后路手术42例。结果术后伤口均一期愈合,神经损伤症状无加重等并发症。获得1 9年,平均3.6年随访者73例。除3例完全性截瘫患者神经功能无变化外,其余病例均有明显恢复,前、后路手术Frankel分级分别平均恢复1.9级与1.5级。植骨块平均愈合时间:前路为4.9个月,后路为5.9个月。结论前后路手术各有其特点,前路手术减压更为充分,神经功能恢复较好,融合成功率较高,脊柱序列维持较好。

Objective To study the clinical outcome of surgical treatments through anterior or posterior approach for thoracolumbar fractures. Methods Seventy-three thoracolumbar fractures cases （39 of them with nerve injury） who had been treated and followed up from March, 1998 to October, 2007 were reviewed. The Frankel scale was used for assessment of nerve function. Three cases were rated as Grade A, 12 as Grade B, 16 as Grade C, and 8 as Grade D before surgery. The surgical approach was chosen according to condi- tions of the injury. Thirty one cases received anterior approach operation and 42 cases received posterior approach operation. Results The mean follow-up period was 3.6 years （ ranged 1 -9 years）. There were no severe postoperative complications, such as deterioration of nerve function. All the cases showed notable im- provement, excepet in 3 cases of complete paraplegia. The improvement was 1.9 and 1.5 Frankel grades, and the average healing period of graft bone was 4. 9 and 5.9 months respectively for the anterior and posterior approach operations. Conclusion The anterior and posterior approaches are different in advantages and characteristics. The surgery through anterior approach provides more decompression good recovery rate of the nerve function, high rate of fusion and better maintenance of sagittal plane alignment.