前后路减压治疗胸腰段脊柱骨折合并脊髓损伤的对比分析

Clinical analysis of anterior and posterior decompressions for treating thoracolumbar spine fractures combined with spinal cord injury

目的比较分析前后路减压治疗胸腰段骨折合并脊髓损伤患者的手术方法及其疗效。方法回顾性分析2013年5月~2015年2月住院治疗的60例胸腰段骨折合并脊髓损伤患者的临床资料,根据手术方法分为前路组和后路组（各30例）,前路组采用前路减压法治疗,后路组采用后路减压法治疗,比较两组患者治疗时间、出血量以及触觉评分、运动评分、伤椎高度、Cobb’s角。结果前路组平均术中出血量（598.3±46.1）m L,后路组（358.2±34.1）m L,前路组多于后路组（P〈0.05）;后路组平均手术时间（201.6±21.5）min,前路组（243.8±16.8）min,前路组多于后路组（P〈0.05）。两组治疗前触觉评分及运动评分均无差异（P〉0.05）。后路组治疗后平均触觉评分为（56.4±12.2）分、运动评分为（54.4±14.8）分,前路组则分别为（76.0±14.5）分、（76.5±18.3）分,两组均较治疗前显著改善,且前路组优于后路组（P〈0.05）。前路组治疗后平均Cobb’s角（44±5）°、伤椎高度（3.8±0.5）cm,后路组（31±2）°、（2.5±0.4）cm,两组均较治疗前显著改善,且前路组相比后路组治疗后更优（P〈0.05）。结论前后路减压疗法各有优势,前路减压法复位效果更好,可显著解除脊髓受压情况,改善触觉、运动功能以及伤椎高度、Cobb’s角,在临床上有很大应用前景。

Objective To compare and analyze the surgical methods and clinical effects of anterior and posterior decompressions for treating thoracolumbar fractures with spinal cord injury. Methods The clinical data of60 patients with thoracolumbar fractures combined with spinal cord injury in our hospital from May 2013 to Feb.2015 was retrospectively analyzed. According to the surgical method,the 60 cases were divided into anterior and posterior groups,with 30 cases in each group. The anterior group was treated with anterior decompression,and the posterior group was treated with posterior decompression. The operation time,bleeding volume,tactile score,motor score,vertebral height,and Cobb＇s angle were compared between the two groups. Results The mean blood loss in the anterior group was（ 598. 3 ± 46. 1） m L,and was（ 358. 2 ± 34. 1） m L in the posterior group,which was more in the anterior group than that in the posterior group（ P〈0. 05）. The average operation time was（ 201. 6 ± 21. 5） min in the posterior group,and was（ 243. 8 ± 16. 8） min in the anterior group,which was longer in the anterior group than in the posterior group（ P〈0. 05）. There was no difference between the two groups before treatment in tactile and motor score（ P〈0. 05）. After treatment,the average tactile score was（ 56. 4 ± 12. 2） points and the motor score was（ 54. 4 ± 14. 8） points in the posterior group,and was（ 76. 0 ± 14. 5）,（ 76. 5 ± 18. 3） points,respectively in the anterior group. The two groups were significantly improved after treatment,and the anterior group improved more significantly than the posterior group（ P〈0. 05）. After treatment,the mean anterior Cobb＇s angle was（ 44 ±5） °,the vertebral height was（ 3. 8 ± 0. 5） cm in the anterior group,and was（ 31 ± 2） °,（ 2. 5 ± 0. 4） cm,respectively in the posterior group. The two groups were significantly improved after treatment,and the anterior group improved more significantly（ P〈0. 05）. Conclusion Anterior decompression in the treatment of thoracolumbar fracture with spinal cord injury patients can significantly relieve spinal cord compression and improve tactile and motor function as well as vertebral height and Cobb＇s angle. It is worthy promoting in clinical practice.