胸腰段脊柱骨折伴脊髓损伤的治疗方法体会

The Treatment Experience for Thoracolumbar Spine Fracture with Spinal Cord Injury

目的分析后路椎弓根螺钉内固定和前路减压钉棒内固定两种方法治疗胸腰椎骨折伴脊髓损伤的临床疗效。方法将我院从2009年至2011年收治的120例胸腰段脊柱骨折伴脊髓损伤患者随机均分为后路组60例,行后路减压椎弓根螺钉内固定治疗,前路组60例,行前路减压钉棒内固定治疗。统计分析两组手术情况、神经功能恢复情况、治疗有效率和术后并发症等。结果经术后6～23个月随访,两组术前术后Cobb角的变化和神经功能Frankel结果显示两组术后均优于术前(P<0.05),组间比较差异无统计学意义(P>0.05);后路组总有效率为73.3%,前路组为71.7%,差异无统计学意义(P>0.05)。结论后路椎弓根螺钉内固定和前路减压钉棒内固定两种方法治疗胸腰椎骨折伴脊髓损伤均能取得较好疗效,但后路法并发症少于前路组。

Objective To explore the clinical efficacy of 2 methods （posterior approach or anterior approach）for thoracolumbar fractures with spinal cord injury. Methods 120 patients of thoracolumbar spine fracture with spinal cord injury, were admitted to the hospital from 2009 to 2011, were randomly divided into 2 groups：60 in the posterior group （GP） got posterior pedicle screw fixation and 60 in the anterior group（GA） anterior decompression screw and rod fixation. Collected the relevant datas. Results Follow-up for 6 to 23 months of the cases, and both groups showed significant difference between before and postoperative in Cobb angle changes and neurological function Frankel （P〈0.05）, but no statistically significant between 2 groups（P〉0.05）; so as the rates of curative effect73.3%in GP, 71.7%in GA, （P〉0.05）. Conclusion Both of 2 methods can achieve well curative effect for thoracolumbar fractures with spinal cord injury, but the the posterior approach was better than the way forward, cause the complications is less than the anterior group.