胸腰椎爆裂骨折120例前后路手术效果比较

Clinical study of surgical treatment for thoracolumbar burst fractures 120 cases

目的分析胸腰椎爆裂骨折手术治疗效果,准确掌握手术适应证及入路选择。方法回顾性分析120例手术治疗的胸腰段爆裂骨折患者的临床资料,其中前入路手术65例,后入路手术55例。X射线片评定手术前后伤椎前后缘高度和Cobb角;CT评定椎管减压、椎管占位清除率,并观察植骨融合情况;脊髓神经功能评定采用美国脊髓损伤协会(ASIA)标准。结果随访15～32月,平均18月,无神经损伤加重及内固定断裂等严重并发症,前入路组较后入路组椎体压缩及后凸畸形程度重,术后伤椎复位无明显差异,随访两组Cobb角丢失率差异有显著性意义(P<0.05);前入路手术组较后入路组手术时间长、出血量多,椎管清除率优于后入路组,植骨融合率高于后入路组;两组脊髓神经功能恢复差异无显著性意义(P>0.05)。结论胸腰段爆裂骨折手术治疗效果良好,其手术方式选择应根据骨折类型、损伤程度、椎管占位情况及是否伴有骨折脱位和脊髓神经症状决定。

Objective To analyze the anterior or posterior surgical treatment of thoracolumbar burst fracture of the efficacy,get a better grasp of the indication and approch. Methods Retrospective study in 2004.11-2007.11,surgical treatment of 120 cases of thoracolumbar burst fracture,65 cases through anterior surgical treatment,55cases through posterior surgical treatment. Through X-ray photograph evaluate heights of the anterior and posterior edge of fractured vertebrae and the Cobb＇s angle for preoperative situation,decompression and clearance of spinal canal and fusion rate in CT. To use ASIA standard assessed spinal nerve function. Results The followed-up for 15 to 32 months with average 18 months. There were no postoperative complication,such as deterioration of nerve function ,disruption of internal fixation. The surgery time was longer and more bleeding in anterior group; The patients of anterior group had more serious degree of compression and kyphosis than patients of posterior group. There had no significant difference between the two groups,in preoperative,heights of the anterior and posterior edge of fractured veterbrae and Cobb＇s angle postoperative,both of which were satisfied with the reduction. In preoperative spinal canal space,anterior group spinal canal encroachment clearance rate was significantly superior than the posterior group; Anterior group fusion rate was higher than posterior group. There had no difference between the two groups in function of neurological. Conclusion It is effective through surgical management of thoracolumbar bursting fractures by anterior or posterior approach. The choice of anterior or posterior surgery for thoracolumbar burst fractures depends on type of the fractures,canal encroachments ,concomitant displacement and symptom of neurological.