中上胸椎骨折伴脊髓损伤的治疗及早期康复效果评价

Effect assessment of the treatment for middle-upper thoracic vertebra fracture accompanying spinal cord injury and the early rehabilitation

目的探讨中上胸椎骨折伴脊髓损伤的手术治疗及术后早期康复锻炼的方法,并对术后早期康复锻炼的效果进行评价。方法 2007年9月～2010年8月收治的40例中上胸椎骨折伴脊髓损伤患者,均行后路减压植骨融合椎弓根钉内固定术,其中20例(早期康复组)术后2周内开始康复锻炼,20例(对照组)术后2个月开始康复锻炼。随访12～40个月,观察两组患者术后恢复情况。结果所有患者切口均一期愈合。术后CT复查均显示胸椎序列复位良好,椎弓根钉固定良好,无断裂。术后神经功能有不同程度的改善。40例患者经康复锻炼后ADL(日常生活活动)能力评分高于术前(P<0.05),早期康复组显著优于对照组(P<0.01)。结论中上胸椎骨折伴脊髓损伤者行后路减压植骨融合椎弓根钉内固定术治疗可获得良好的临床疗效,术后早期进行康复锻炼能最大限度提高日常生活活动能力。

Objective To study the surgical treatment for middle-upper thoracic vertebra fracture accompanying spinal cord injury and the early postoperative rehabilitation exercise method as well as to assess effect of the early postoperative rehabilitation exercise.Methods Forty patients with middle-upper thoracic vertebra fracture accompanying spinal cord injury from September 2007 to August 2010 in our hospital,and all of them were treated with posterior decompression,bone graft fusion and vertebral pedicle screw internal fixation.20 cases（early recovery group） began rehabilitation exercise within two weeks after surgery,and the other 20 cases（control group） began rehabilitation exercise two months after surgery.Follow-up of 12 to 40 months,postoperative recovery of the two groups of patients were observed.Results Surgical incisions for all patients were in healing by first intention.All postoperative CT reviews showed good thoracic vertebra sequence reset,good vertebral pedicle screw fixation and no breakage.Postoperative nerve functions for all patients had different degrees of improvement.ADL（activities of daily living） ability score for 40 cases after rehabilitation exercise was higher than their preoperative score（P 0.05）,and the score for early recovery group was significantly better than that in the control group（P 0.01）.Conclusion For the patients with middle-upper thoracic vertebra fracture accompanying spinal cord injury,combined treatment of posterior decompression,bone graft fusion and vertebral pedicle screw internal fixation can obtain good clinical curative effect;and early postoperative rehabilitation exercise can maximize their ADL ability.