不同入路减压内固定治疗胸腰椎爆裂骨折合并脊髓损伤

Different approaches to decompression and internal fixation of thoracolumbar burst fractures with spinal cord injury

目的比较不同入路减压、内固定治疗胸腰椎爆裂骨折合并脊髓损伤的疗效。方法将58例胸腰椎爆裂骨折合并脊髓损伤患者根据椎管骨块占位程度分为前入路组(23例)和后入路组(35例)。分别行椎管减压、植骨、内固定术。对两种方法的手术时间、术中出血量、术中输血量、植骨融合时间、脊柱矫正角度丢失度数、Cobb角及神经功能恢复情况进行评价。结果 58例均获得随访,时间为12～24个月。手术时间、术中出血量、术中输血量:前入路组分别为(205.7±30.1)min、(1 030±110.5)ml、(650.0±42.5)ml,后入路组分别为(110.4±25.8)min、(460.8±40.3)ml、(180.8±76.3)ml,两组差异有统计学意义(P<0.01)。神经功能Frankel分级:两组A级均有1例无恢复,余均有1～2级的恢复。植骨融合时间:前入路组为(3.4±1.3)个月,后入路组为(4.8±1.1)个月,两组差异有统计学意义(P<0.05)。脊柱矫正角度丢失度数:前入路组为2.0°±1.0°,后入路组为5.0°±1.5°,两组差异有统计学意义(P<0.05)。Cobb角:两组术后1周与术前比较差异均有统计学意义(P<0.05),术后1周两组间比较差异无统计学意义(P>0.05);术后1周与末次随访时比较两组差异有统计学意义(P<0.05)。结论胸腰椎爆裂骨折合并脊髓损伤手术方式应根据骨折类型、部位及椎管受压程度,严格掌握适应证,采用前入路或后入路均能取得较好的疗效。

Objective To compare the effect of different approaches to decompression and internal fixation of thoraco- lumbar burst fractures with spinal cord injury results. Methods 58 cases of thoracolumbar burst fractures with spinal cord injury patients were divided into anterior approach group （23 cases） and posterior approach group （35 cases） according to the fragment encroachment of spinal canal. All cases were underwent spinal canal decompression, bone grafting, and internal fixation. The two methods were compared of operation time, blood loss, intraoperative blood transfusion, bone graft and fusion time, loss of spinal correction angle in degrees Cobb angle, and recovery of neuro-logical function evaluation. Results 58 cases were followed up for 12 - 24 months. Operative time, blood loss, intraoperative blood transfusion in the anterior group were （205.7 ±30. 1 ） min, （ 1 030 ± 110. 5） ml, （650. 0 ±42. 5） ml, and ifi the posterior approach group （110. 4 ± 25.8） min, （460. 8 ± 40. 3） ml （180. 8 ± 76. 3 ） ml, respective- ly,the two groups was statistically significant difference （P 〈 0. 01 ）. Nerve function Frankel grade： Grade A with 1 in each group got no recovery, the remains got recovery 1 -2 degree. Interbody fusion： the anterior approach group was （ 3.4 ± 1.3 ） months ; the posterior approach group was （4. 8± 1. 1） months, the difference was statistically signiticant （ P 〈 0.05 ）. Approach group in spinal correction angle loss of degree ： the anterior approach group was 2. 0° ± 1.0°, and the posterior group was 5.0° ± 1.5°, the difference was statistically significant （P 〈0. 05）. Cobb angle ： the two groups after one week with the preoperative difference was statistically significant （ P 〈 0. 05 ）, while difference was not statistically significant （P 〉 0. 05 ） between the two groups after 1 week ; One week after the operation and the last follow-up in both groups, there was significant difference （ P 〈 0. 05 ）. Conclusions Thoracolumbar burst fractures with spinal cord injury should be based on the fracture type, location and degree of spinal compression, strict indications, anterior or posterior approach to achieve better efficacy.