无神经症状的胸腰椎爆裂性骨折手术和非手术疗效的比较

Operative versus non-operative treatment for thoracolumbar burst fractures without neurological deficit

目的:对没有神经症状的胸腰椎爆裂性骨折手术和非手术治疗的疗效进行比较,探讨治疗方法的选择。方法:复习从2002年1月～2006年1月共收治不伴有神经症状的胸腰椎爆裂性骨折病例98例,其中非手术治疗47例,手术治疗51例。对骨折遗留后凸畸形、矫正后椎体高度丢失、腰部疼痛改善和患者功能恢复进行分析及统计学处理。结果:平均随访2.2年,随访结果发现,手术组患者局部或者整体后凸畸形及椎体高度丢失情况明显较保守治疗组轻;而保守治疗组腰部疼痛改善及功能评分明显较手术组理想,但差异没有统计学意义(P>0.05)。结论:对没有神经症状的胸腰椎爆裂性骨折,与非手术治疗相比,手术治疗在长期疗效方面并没有优势。保守治疗似乎应该是最优先的选择,只有当这种选择失效时再进行手术治疗。

Objective To compare operative with non-operative treatment for thoracolumbar burst fractures without neurological deficit and choose a better method for clinical application.Method A retrospective study was performed on 98 cases of thoracolumbar burst fractures without neurological deficit treated from January 2002 to January 2006.Non-operative treatment group had 47 cases and 51 cases in operative treatment group.The data of Kyphosis,Loss of Vertebral Body Height,JOA and Frankel were analyzed and statistical descripted.Results All cases were followed up for an average of 2.2 years to evaluation the different clinical results.The clinical results in operative treatment group showed better outcome than that in non-operative treatment group at Kyphosis and Loss of Vertebral Body Height.The clinical results of JOA and Frankel in non-operative treatment group were better than that in operative treatment group,but without statistical difference.Conclusion We find that operative treatment of patients with thoracolumbar burst fractures without neurological deficit provides no major long-term advantage compared to non-operative treatment,which should be the first choice except it is failure.