后路间接复位术和椎板切除治疗合并脊髓神经损伤的胸腰椎爆裂性骨折

Posterior indirect reduction and internal fixation and laminectomy in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury

目的观察后路间接复位术和椎板切除治疗胸腰椎爆裂性骨折合并脊髓神经损伤的临床疗效。方法选取我院2014年3月至2015年3月收治的胸腰椎爆裂性骨折合并脊髓神经损伤患者80例作为研究对象,按手术方法分为复位术组和去椎板组,各40例。术后均随访1年,分别于术后1周、术后1年观察2组患者腰椎功能,于术后1个月、3个月、6个月观察患者疼痛程度,观察患者术中出血量、手术时间、住院时间以及骨折愈合时间,采用美国脊髓损伤学会分级标准(ASIA)对神经功能情况进行评估,统计并发症发生率。结果 2组患者术后1周、术后1年伤椎前缘高度较术前升高,Cobb’s角较术前降低,差异均具有统计学意义(P<0.05),2组患者术后1周、术后1年伤椎前缘高度差异无统计学意义(P>0.05);2组患者术后1个月、术后3个月、术后6个月VAS评分均较术前下降,且复位术组各个时刻VAS评分低于去椎板组,差异均具有统计学意义(P<0.05),组内各时刻间比较差异均具有统计学意义(P<0.05);复位术组术中出血量、手术时间、住院时间以及骨折愈合时间均少于去椎板组,差异具有统计学意义(P<0.05);2组患者术后1年神经功能恢复情况均较术前显著改善,差异有统计学意义(P<0.05),组间比较差异无统计学意义(P>0.05);复位术组并发症发生率为7.50%,低于去椎板组12.50%,差异有统计学意义(P>0.05)。结论后路间接复位术和椎板切除治疗胸腰椎爆裂性骨折合并脊髓神经损伤均有一定效果,但后路间接复位术术后并发症少,术中出血量少,有利于患者术后恢复。

Objective To explore the clinical effect of posterior indirect reduction and internal fixation and laminectomy in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury. Methods Eighty patients with thoracolumbar vertebrae burst fracture and spinal cord injury treated in our hospital from March 2014 to March 2015 were selected as the objects, and they were divided into reset group and laminectomy group with forty cases in each group according to surgical method. All the patients were followed up for 1 year, the lumbar function of two groups at 1 week and 1 year after operation were observed respectively, and the pain degree was observed in 1 month,3 months and 6 months after operation. The amount of bleeding,operation time, hospitalization time and fracture healing time were ob- served. Neurological function was assessed by classification criteria of the American Spinal Cord Injury Association（ASIA） , and incidence of complications was figured in the two groups. Results The anterior heights of the injured vertebra were higher than those before the operation, and the Cobb＇ s angles were lower than those before the operation,the differences were significant（P 〈 0.05 ） ;while there was no significant differences in the anterior heights of the injured vertebra between the two groups at 1 week and 1 year after operation（ P 〉 0.05 ）. VAS scores of the two groups after 1 month,3 months and 6 months decreased significantly when compared with the preoperative scores（ P 〈 0.05 ） , and VAS scores of each time in the reset group were significantly lower than those in the laminectomy group （P 〈 0.05 ）. The amount of bleeding, operation time, hospitalization time and fracture healing time in the reset group were less than those in the laminectomy group （ P 〈 0.05 ）. The neurological function recovery of the two groups were significantly improved when compared with that before the operation（ P 〈0.05 ）. There was no significant difference in recovery of neurological function between the two groups （ P 〉 0.05 ）. The complication rate was 7.50% in the reset group, lower than 12.50% of the lamineetomy group,the difference was significant（P 〈 0.05）. Conclusion Posterior indirect reduction and internal fixation of lamina both have a certain effect in the treatment of thoracolumbar vertebrae burst fracture complicated with spinal cord injury. But posterior indirect reduction has less complications and less amount of bleeding,which is beneficial to postoperative recovery.