改良Load-sharing评分对胸腰段脊柱骨折手术的指导价值

Improved Load-Sharing Scoring System for The Choice of Surgical Method in The Treatment of Thoracolumbar Spine Fracture

目的探讨改良Load-sharing评分对胸腰段脊柱骨折手术治疗方法选择的指导价值。方法选取2012年9月至2014年9月我院收治的69例胸腰段脊柱骨折患者为研究对象,根据改良Load-sharing评分选择不同的手术方式,对于评分为4~6分的患者应用后路手术;对于评分≥7分且保留完整骨折椎后方结构、不伴有脱位的患者,应用前路手术＋骨折椎体次切＋前路植骨术;对于评分≥7分且骨折椎后方结构破坏或伴有脱位的患者,应用前后路联合手术＋骨折椎体次切＋前路植骨术。观察记录临床治疗效果。结果所有患者的后凸角、椎管占位及椎体压缩于手术后均得到恢复,与手术前比较差异具有统计学意义（P〈0.05）。40例不完全性神经功能损害患者中,3级神经功能恢复者2例,2级神经功能恢复者14例,1级神经功能恢复者24例。根据Denis分级对术后腰痛评价分级,P1 49例,P2 14例,P3 6例。术后31例恢复原来从事工作或体力劳动,32例更换较轻松工作或轻体力劳动,6例生活能自理但不能参加正常工作及劳动。结论改良Load-sharing评分对胸腰段脊柱骨折手术治疗方法的选择具有重要指导价值。

Objective To explore the values of the improved Load-Sharing scoring system for the choice of surgical method in the treatment of thoracolumbar spine fracture. Methods The 69 thoracolumbar spine fracture patients from September 2010 to January 2014 in our hospital were selected and accepted different surgery approach according to modified Load-sharing score. Posterior surgery was suitable for 4 - 6 scores. Anterior surgery ＋ subtotal vertebrectomy ＋ anterior bone graft was suitable for≥7 scores without vertebral rear structural damage or dislocation. Anterior combined posterior surgery ＋ subtotal verte- brectomy ＋ anterior bone graft were suitable for≥7 scores with vertebral rear structural damage or dislocation. Clinical results were recorded. Results Cobb angle, spinal canal and vertebral compression in all patients were restored after surgery. The difference between pre-and post-surgery was statistically significant（ P 〈 0.05 ）. There were 40 patients of incomplete neurological impairment in which 2 cases of neurological recovery by 3,14 cases of neurological recovery by 2 and 24 cases of neurological recovery by 1. The evaluation of low back pain according to Denis classification were 49 cases of P1,14 cases of P2 and 6 cases of P3.31 cases backed to the original work or physical labor. 32 cases had light work. 6 cases lived without aid but could not participate in normal work and labor. Conclusion The improved Load-Sharing scoring system has important guiding value for the choice of surgical method in the treatment of thoracolumbar spine fracture.