后路小切口270°减压重建术与单纯前路减压植骨内固定术治疗严重胸腰椎骨折的对比研究

Comparative study of posterior 270° decompression and reconstruction via a posterior small incision approach and simple anterior decompression and fixation approach in treatment of severe thoracolumbar spine fracture

目的比较后路小切口270°减压重建术与单纯前路减压植骨内固定术治疗严重胸腰椎骨折的临床疗效,为术式选择提供依据。方法回顾性分析2005年12月至2008年12月采用后路小切口270°减压重建术(A组,n=13)和单纯前路减压植骨内固定术(B组,n=11)治疗严重胸腰椎骨折患者的临床和影像学资料。Frankel分级评价神经功能。X线片、CT评估伤椎Cobb角的矫正和丢失情况、椎管减压范围及植骨融合情况,并观察手术并发症。结果所有患者得到14～36个月(26个月)随访,A组平均手术时间、术中出血量及术后引流量分别为229min、1353ml及433ml;B组为212min、1107ml及261ml,两组差异无统计学意义(P>0.05)。术后Cobb角矫正度及末次随访时的丢失角度两组分别为:A组为21.8±4.4和1.0±0.9,B组为18.7±8.4和1.3±1.0,两组间差异无统计学意义(P>0.05)。Frankel分级A组1例由术前B级恢复到C级,A、B组分别5例、4例由C级恢复到D或E级,3例、4例由术前D级恢复到术后E级,分别改善1.0、1.1级,两组差异无统计学意义(P>0.05)。结论后路小切口270°减压重建术与单纯前路减压植骨内固定术治疗严重胸腰椎骨折的临床疗效无显著差异;两者各有优缺点及其适应征,应根据骨折类型、伤椎椎体压缩程度、椎管内骨性占位程度以及是否伴有脊柱后柱结构不稳或骨折脱位来合理选择手术方式。

Objective To compare the surgical results of posterior 270°decompression and reconstruction via a posterior small incision approach and simple anterior decompression and fixation approach in treatment of severe thoracolumbar spine fracture,and to provide the basis for the operation of the pre-selection basis.Methods Clinical and radiographic results of posterior 270°decompression and reconstruction（A,n=13） and simple anterior decompression and fixation（B,n=11） in treatment of severe thoracolumbar spine fracture were analyzed retrospectively from December 2005 to December 2008.Neurological status was judged by Frankel grades.X-ray and CT was used for evaluation of the correction and loss of Cobbs angle,the decompression scope of spinal canal and the fution.Complications related to operation and devices were also considered.Results Thefollow-up periods ranged from 14 to 36 month（average 26 Ms）.The mean operation time,perioperative bleeding,postoperative drainage were 229 min,1353 mL,and 433 mL respectively in A group,and 212min,1107mL,and 261mL in B group.The mean operation time,perioperative bleeding,postoperative drainage were 229 min,1353 mL,and 433 mL respectively in A group,and 212min,1107mL,and 261mL in B group.There was no significant difference between groups A and B（P 0.05）.In A group,the correction of Cobbs angle and the lost at the last follow-up were 21.8±4.4 and 1.0±0.9 respectively;while in the B group,those were 18.7±8.4 and 1.3±1.0 respectively.There was no significant difference between groups A and B（P 0.05）.In Frankel grades,1（A） cases improved from B to C postoperatively,and 5（A）/4（B） cases improved from B to C or D,3（A）/4（B） cases improved from D to E.The improvements were 1.0 and 1.1 grades respectively for the posterior 270°decompression and reconstruction and simple anterior decompression and fixation,There was no significant difference between two groups（P 0.05）.Conclusion In treatment of severe thoracolumbar spine fracture,posterior 270°decompression and reconstruction via a posterior small incision approach and simple anterior decompression and fixation approach can obtain similar clinical results and neurological recovery.The two methods both have advantages and disadvantages and are suitable to different people.According to the type of fracture,the vertebral compression,canal encroachment,posterior column stability and concomitant displacement,different operation methods should be chosen.