胸腰椎爆裂性骨折后椎管重建——兼论非手术治疗的意义

Remodelling of the spinal canal after thoracolumbar burst fractures: significance of nonoperative management

目的 证实胸腰椎爆裂性骨折后的椎管重建现象 ,并探讨非手术治疗的意义。 方法 回顾性分析 31例胸腰椎爆裂性骨折 ,其中未治疗 7例 ,非手术治疗 16例 ,手术治疗 8例。随访时间 3～ 7年。记录初次诊治入院时和随访时脊髓损伤程度 ,以及出院和随访时椎管狭窄率。 结果 31例患者的椎管狭窄率由初次诊治出院时的 12 3%～ 74 5 % (平均 2 6 2 % )降至随访时的 5 4%～46 5 % (平均 19 2 % ) ,差异具有极显著性意义 (P <0 0 1)。其中未治疗、非手术治疗及手术治疗三组患者的椎管狭窄率变化无显著性 (P >0 0 5 )。不同程度脊髓损伤患者的椎管狭窄改善率相差无显著性 (P >0 0 5 )。 结论 胸腰椎爆裂性骨折后存在明显的椎管重建。对于胸腰椎爆裂性骨折不合并神经损害者 ,可考虑非手术治疗。

Objectives [WT5”BZ]To determine the phenomenon of remodelling of the spinal canal after thracolumbar burst fracture and to investigate the efficacy of nonoperative management. [WT5”HZ]Methods [WT5”BZ]A total of 31 patients with thoracolumbar burst fractures, including 7 untreated, 16 treated nonoperatively, and 8 treated operatively, were retrospectively analysed and followed up for 3 to 7 year. The initial and final degrees of neurological deficit and stenostic ratio of the spinal canal were recorded. [WT5”HZ]Results [WT5”BZ]The stenotic ratio significantly decreased ( P <0 01) from the discharge (range: 12 3% to 74 5%, average: 26 2%) to the final follow up (range: 5 4% to 46 5%, average: 19 2%), but there were no differences ( P >0 05) of stenotic ratio improvement among the patients untreated, and treated nonoperatively and operatively, or among the patients with different degree of neurological deficit. [WT5”HZ]Conclusions [WT5”BZ]Significant remodelling of the spinal canal develops after thoracolumbar burst fractures. Nonoperative management may be taken into account for treatment of neurological intact patients with thoracolumbar burst fractures. [WT5”HZ]