不同手术方法治疗胸腰段骨折脱位并截瘫的临床疗效比较

Thoracolumbar fracture and dislocation:a retrospectively comparison of various surgical outcome

目的：分析比较不同手术方法治疗胸腰段骨折脱位并截瘫的疗效差异及内固定装置的利弊。方法：对1996～2009年240例急性胸腰段骨折脱位伴截瘫所施行的前路Armstrong钢板、Kaneta装置和后路Harrington棒、Luque棒的患者的临床资料进行回顾分析。结果：前、后路手术神经功能的恢复率分别为88%和76%（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〈0.05）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面各术式无明显差异（P〉0.05）。结论：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。

Obejective：To compare the outcome of different surgeries in the treatment of thoracolumbar fracture and dislocation associated with paraplegia.Methods：From 1996 to 2009,clinical data of 240 patients with thoracolumbar fracture and dislocation associated with paraplegia were studied retrospectively.Sixty-eight patients were managed with anterior decompression,Armstrong plate or Kaneta device fixation.One hundred and seventy-two cases were operated with posterior approach and Harringtons rod,Luque rod,Dick screw or RF operation.Results：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 posterior＇s.The rate of neurological funtional recovery was 88% and 76% respectively（P0.05）,but there was no significant intergroup dlfference when considering postoperative complication,kyphotic and compresisve correction,and duration of hospital stay（P0.05）.Conclusion：These observations suggested that the surgical approachs and fixation must depend on the canal compressive site as well as in accord with the principle of spinal biomechanics.