胸腰椎骨折伴脊髓损伤手术治疗方式选择的临床研究

Clinical Research of Choosing Surgical Treatment of Thoracolumbar Fracture with Spinal Cord Injury

目的:探讨胸腰椎骨折伴脊髓损伤的手术方式选择策略。方法:回顾性分析本院收治的104例胸腰椎骨折伴脊髓损伤患者,并根据患者伤情,采取不同的手术方式,其中经前路手术41例,经后路手术63例;术后根据患者个体情况进行随访,对比2种手术方式对患者的中远期影响。结果:与前路手术比较,后路手术用时和出血量均较少,差异有统计学意义(P<0.05)。两种手术方法治疗前后,Frankel分级和Cobb角测量值比较差异均有统计学意义(P<0.05);且治疗后前路手术对Cobb角的改善度显著优于后路手术(P<0.05)。结论:采用前路、后路手术方法均能较好地复位固定伤椎;后路术式创伤小,操作相对简单,术后合并症少,但存在锥体高度丢失隐患,前路减压较彻底,远期稳定性好,但对医疗条件及手术技术要求较严格,且费用较高,临床治疗时须具体分析以选择合适的术式治疗。

Objective：To study the operation mode selection strategy of thoracolumbar fracture with spinal cord injury.Method：104 cases of thoracolumbar fracture with spinal cord injury patients in our hospital were retrospectively studied,and according to patients condition,to adopt different ways of operation,41 cases were given anterior approach operation and 63 cases were given posterior approach operation.After operation,patients were followed-up according to individual condition,and the long-term effects of two kinds of operation for patients were compared.;Follow-up postoperative patients according to individual circumstance,and to compare the three kinds of surgical procedure for patients with long-term effects.Result：The operation time and blood loss of patients operated with the posterior surgery were significantly less than that with the anterior surgery（P〈0.05）.There were both significantly different for the two groups in Frankel classification and Cobb Angle before and after treatment（P〈0.05）.And the improvement of the Cobb Angle for patients with anterior surgery was significantly better than that with posterior surgery（P〈0.05）.Conclusion：The anterior and posterior surgery method all can fixation vertebral well.Posterior surgical trauma is small,relatively simple operation,and less postoperative complications,but there has cone height loss risk.Anterior decompression is thorough,long-term stability is good,but is strict with medical conditions and surgical technique,and the cost is higher,so clinical treatment must be concrete analysis to select the appropriate surgical treatment.