早期手术治疗胸腰椎爆裂性骨折的临床研究

The clinical research of early surgical treatment of thoracolumbar burst fractures

目的:探讨早期手术对胸腰椎爆裂性骨折的治疗价值,以选择最佳手术时机。方法:回顾性分析我院2006年4月～2008年4月手术治疗的新鲜胸腰椎爆裂性骨折68例,按伤后接受手术时间(72h以内及72h以后)将患者分为A、B两个治疗组,进行术前及术后影像学观察指标与神经损伤恢复程度比较。通过影像学检查观察伤椎高度恢复、Cobb角及椎管占位情况,脊髓损伤的神经功能按ASIA2000标准进行分级及评分。结果:68例随访12～24个月,平均15个月。术后68例患者的伤椎高度、Cobb角及椎管占位均获得明显改善;组间比较,A组患者的改善情况较B组明显,差异有统计学意义(P<0.05)。神经损伤恢复结果提示,A、B两组术后均有不同程度的恢复,A组患者的恢复程度较B组明显,差异有统计学意义(P<0.05)。结论:手术治疗胸腰椎爆裂性骨折疗效显著,伤后手术时间越早,术后脊髓神经功能恢复越好;在全身情况允许时,对脊髓损伤患者尽可能在早期行内固定减压手术,以最大程度地恢复脊髓神经功能。

Objective： To study the effect of early surgery for thoracolumbar burst fractures in order to choose the best time of surgery. Methods： 68 cases of thoraeolumbar burst fractures underwent surgical treatment in our hospital from April 2006 to April 2008 were retrospectively analyzed. According to the operation time after injury, the patients were divided into group A （within 72 hours） and group B （more than 72 hours）. The recovery of the height of the injured vertebral body, the Cobb angle and the spinal canal impingement as well as the spinal nerve function recovery degree of the two groups were compared. The degree of nervous function was performed by the standard of ASIA2000. Results： 68 eases were followed up for 12-24 months （average 15 months）. The vertebral height, Cobb angle and the spinal canal impingement were significantly improved in both groups. The difference of the improvement between the two groups was significant （P〈0.05）. The recovery of the spinal cord injury was obvious in both groups. The difference of the recovery between group A and group B was significant （P〈0.05）. Conclusion： The surgical operation has obvious effect, and the earlier the operation is conducted, the better nervous function recovery is got. If the condition allows, the operation should be done as early as possible to get the largest extent of the restoration of spinal cord nerve function.