胸腰段骨折脱位并截瘫手术内固定疗效比较(附193例报告)

Thoracolumbar Fracture and Dislocation: A Retrospectively Comparison of Various Surgical Outcome

本文对1984～1997年242例急性胸腰段骨折脱位伴截瘫所施行的后路Harrington棒,Luque棒和前路Armtstrong钢板、Kaneta装置的病人进行了回顾分析,旨在对各种手术方法及内固定的利弊与疗效进行比较。结果表明:前、后路手术神经功能的恢复率分别为87％和74％(P<0.05),前路手术在解除椎管压迫和神经功能的恢复上明显优于后路手术。除手术耗时及输血量前路手术多于后路手术(P<0.01)外,椎体压缩的恢复,后凸角的矫正和手术并发症及住院日期方而各术式无明显的差异(P>0.05)。认为胸腰段骨折手术途径及固定方法宜根据脊柱生物力学的破坏程度、脊髓受压的部位进行选择,手术时机最好在伤后3～7d。

A retrospectively study of 242 patients with thoracolumbar fracture and dislocation associated with paraplegia was done to assess the outcome of various surgery. Sixty-nine patients were managed with anterior decompression, Armstrong plate or Kanela device fixation; one hundred and seventy- three cases were operated with posterior approach and Harringtons rod, Luque rod, Dick screw or RF operation. All patients were followed up for an average of 1.5 years. The relief of spinal canal compression and neurological deficit improved for anterior approach surgery were superior to pos-terior' s, the rate of neurological funtional recovery was 87% and 74% respectively (P<0.05); but there was no sig-nificant inlergroup difference when considering postoperative complication, kyphotic and compressive correction, and du-ration of hospital stay (P>0.05). These observations suggested that the surgical approachs and fixation must depended on the canal compressive site as well as in accord with the principle of spinal biomechanics.