不同手术入路内固定融合术治疗胸腰段脊柱骨折的效果比较

Effect comparison of different surgical approach of fusion and fixation in the treatment of thoracolumbar spinal fracture

目的观察比较不同手术入路内固定融合术治疗胸腰段脊柱骨折的效果。方法选取山东省寿光市人民医院2013年8月~2015年1月收治的84例胸腰段脊柱骨折患者,将所有患者随机分为前路组和后路组,每组42例。前路组采用前路内固定融合术,后路组采用后路内固定融合术。比较两组的临床疗效、手术时间、术中出血量、住院时间、运动与触觉评分以及术后并发症发生情况。结果前路组的总有效率为85.71%,后路组为95.24%,两组比较差异有统计学意义（P〈0.05）。后路组的手术时间[（156.53±18.20）min]、住院时间[（10.26±2.42）d]明显短于前路组[（223.27±24.29）min、（15.33±3.25）d],术中出血量[（634.47±37.95）ml]明显少于前路组[（986.25±42.73）ml],差异均有统计学意义（P〈0.05）。前路组与后路组患者治疗后的运动与触觉评分[（56.8±6.5）、（62.5±6.8）分;（63.2±7.1）、（65.3±7.7）分]均较治疗前[（37.3±4.2）、（46.5±6.1）分;（41.3±5.3）、（49.1±6.3）分]显著提高（P〈0.05）,但两组治疗后的运动与触觉评分比较,差异无统计学意义（P〉0.05）。前路组的术后并发症发生率为4.76%,后路组为9.52%,两组比较差异无统计学意义（P〉0.05）。结论后路内固定融合术治疗胸腰段脊柱骨折的效果明显优于前路内固定,能明显缩短手术时间、住院时间,减少术中出血量,值得临床推广应用。

Objective To observe the effect of different surgical approach of fusion and fixation in the treatment of tho-racolumbar spinal fracture. Methods 84 cases of patients with thoracolumbar spinal fractures admitted into Shouguang People’s Hospital of Shandong Province from August 2013 to January 2015 were selected and randomly divided into anterior group and posterior group,and there were 42 cases in each group.The anterior group was given anterior fusion and fixation,while the posterior group was given posterior fusion and fixation.The clinical effect,operation time,intraop-eratve blood loss,length of stay,movement and tactile score and incidence of postoperative complication between two groups was observed and compared respectively. Results The total effective rate of anterior group was 85.71%,which of posterior group was 95.24%,the difference was statistically significant （P〈0.05）.The operation time [（156.53±18.20） min] and length of stay [（10.26±2.42） d] of posterior group was significantly shorter than that of anterior group [（223.27±24.29） min, （15.33±3.25） d] respectively,the intraoperative blood loss [（634.47±37.95） ml] was significantly less than that of anterior group [（986.25±42.73）ml],the differences were all statistically significant （P〈0.05）.The movement and tactile score after treatment of anterior group and posterior group [（56.8±6.5）,（62.5±6.8） points; （63.2±7.1）,（65.3±7.7） points] were all increased significantly than before treatment [（37.3±4.2）,（46.5±6.1） points; （41.3±5.3）,（49.1±6.3） points] （P〈0.05）,while there were no significant difference of movement and tactile score between two groups after treatment （P〉0.05）.The incidence rate of postoperative complication in anterior group was 4.76%,which of posterior group was 9.52%,the difference was not statistically significant （P〉0.05）. Conclusion Posterior fusion and fixation in the treatment of thoracolumbar spinal fracture has better effect than anterior fusion and fixation,which can significantly shorten opera-tion time,length of stay,reduce intraoperative blood loss,which is worthy of clinical promotion and application.