后路间接减压植入物内固定与后路椎板切除直视下减压内固定治疗胸腰椎爆裂骨折

Posterior indirect-decompression technique versus posterior direct vision decompression for thoracolumbar burst fractures

背景：对于后纵韧带复合体完整的胸腰椎爆裂骨折是否需要减压,采用何种复位效果较为可靠,尚缺乏临床对照研究。目的：对比后路间接减压植入物内固定与后路椎板切除直视下减压内固定治疗后纵韧带复合体完整的后柱牵张性损伤胸腰椎爆裂骨折的临床效果。方法：纳入后纵韧带复合体完整的后柱牵张性损伤胸腰椎爆裂骨折患者48例,其中23例采用后路间接减压植入物内固定修复,25例采用后路椎板切除直视下减压内固定修复。观察固定后并发症、脊柱后凸畸形矫正情况、椎管占位复位和神经损伤恢复程度。结果与结论：所有患者随访20~25个月,随访期间,采用后路间接减压植入物内固定修复患者的早期并发症发生率、远期残留背痛及活动受限的发生率均低于采用后路椎板切除直视下减压内固定修复的患者;固定后1周,后路间接减压植入物内固定后椎体前后缘高度、Cobb角纠正程度优于后路椎板切除直视下减压内固定,固定后1年,两组患者脊柱后凸畸形纠正程度、神经损伤恢复情况差异无显著意义。说明对于后纵韧带复合体完整的后柱牵张性损伤胸腰椎爆裂骨折应优选后路间接减压植入物内固定进行修复。

BACKGROUND： Whether thoracic or lumbar vertebral burst fracture with intact posterior longitudinal ligament complex needs decompression and which reduction effect of adopted methods is reliable, now there is little controlled clinical studies. OBJECTIVE： To investigate and discuss the clinical effect of posterior open-reduction and indirect-decompression technique （POIT） in the treatment of thoracic or lumbar vertebral burst fracture caused by posterior column stretch injury with intact posterior longitudinal ligament complex, and to analyze the two operation methods： POIT and posterior open-reduction and direct vision decompression technique （PODT）. METHODS： Totally 48 cases with thoracic or lumbar vertebral burst fracture caused by posterior column stretch injury with intact posterior longitudinal ligament complex were divided into two groups randomly. Twenty-three cases were treated with POIT and twenty-five cases were treated with PODT. Complications rate, kyphosis correction, vertebral tube occupying place and recovery of nerve injury were observed. RESULTS AND CONCLUSION： The patients were all followed up from 20 to 25 months. The incidence of early complications, long-term residual back pain and incidence of activity limitation in the POIT group were lower than those in the PODT group. One week after fixation, anterior and posterior heights of vertebral body and Cobb angle correction in the POIT group were higher than those in the PODT group. There was no statistical difference of the recovery of nerve injury and the loss of reduction in the two groups after 1 year postoperation. It is indicated that using POIT technique to treat the thoracic or lumbar vertebral burst fracture caused by posterior column stretch injury with intact posterior longitudinal ligament complex is an appropriate technique, and the outcomes of the POIT operation is better than the PODT operation.