胸腰段骨折前路与后路手术对侧方成角的影响

Effect of anterior versus posterior procedures on lateral angulation in thoracolumbar fractures

[目的]探讨胸腰段骨折前路与后路手术纠正脊柱侧方成角的效果。[方法]回顾分析本院自2007年1月~2011年6月胸腰段骨折手术患者117例,行前路手术者42例,行后路手术者75例。术后随访时间3~19个月,平均11.5个月,随访率91.4%,行术前、术后早期、末次随访时冠状位Cobb角测量并比较。[结果]对于术前冠状面Cobb角>5°病例,前路手术术后冠状面Cobb角减小值较后路手术大(t=5.94,P<0.05);对于术前冠状面Cobb角<5°病例,前路手术较后路手术术后侧方畸形发生率更高(x^2=4.88,P<0.05);前或后路手术患者如术后冠状面Cobb角小于10°,当其骨性愈合时冠状面Cobb角并未明显进展(P>0.05);如术后冠状面Cobb角≥10°,其骨性愈合时冠状面Cobb角较前有进展(P<0.05)。[结论]胸腰椎前路手术较后路手术能更好矫正侧方成角畸形,但也增加发生医源性侧凸畸形的风险;胸腰椎骨折术后出现或存留轻度侧凸畸形通常不会导致畸形持续进展,亦不产生明显临床症状,可以保守观察。

[Objective]To explore effect of anterior versus posterior procedures on lateral angulation for treatment of thoracolumbar fractures. [Method]A retrospective study was done on 117 patients with thoracolumbar combined section fractures in our hospital from January 2007 to June 2011. There were 42 patients treated by anterior procedures,while the remaining 75 cases treated with posterior approach. The patients were followed up from 3 to 19 months with an average of 11. 5 months. Cobb angles on the coronal plane were measured and compared pre- and post- operatively,and at the latest follow up. [Result]In the patients whose preoperative Cobb angles in the coronal plane was more than 5°,the angles in the anterior approach group decreased significantly than in the posterior approach group after operation（ t = 5. 94,P〈0. 05）. Additionally,the incidence of postoperative coronal malformation in the anterior approach group was higher than in the posterior approach group in the patients who had the Cobb angles less than or equal to 5° before operation（ x2= 4. 88,P〈0. 05）. Comparing the Cobb angles immediately after operation with those at the latest follow up,there were no remarkable changes in the angle if the patient had Cobb angle less less than 10° after operation（ P〈0. 05）. By contrast,the angles increased significantly at the latest follow up if the patient presented Cobb angle more than or equal to 10° immediately after operation（ P〈0. 05）. [Conclusion]The anterior procedure has better potential to correct the coronal deformity fractures,however,is also associated with high risk of iatrogenic malformation,compared to the posterior procedure for treatment of thoracolumbar fracture. The mild malformation on the coronal plane secondary to thoracolumbar fracture would not progress considerably to induce obvious clinical symptoms,therefore,could be observed and treated conservatively.