不同后路手术方式治疗胸腰椎爆裂骨折合并脊髓神经损伤的对比观察

Comparison of different posterior surgical methods in the treatment of thoracolumbar burst fracture combined with spinal cord injury

目的 探讨不同后路手术方式治疗胸腰椎爆裂骨折合并脊髓神经损伤的效果.方法 选取我院61例胸腰椎爆裂骨折合并脊髓神经损伤患者,随机分组,对照组30例,观察组31例,对照组予以后路直接减压复位内固定治疗,观察组予以后路间接减压复位内固定治疗,观察比较两组围术期出血量、手术用时、术后Frankel神经功能分级及伤椎前缘高度、后凸Cobb角变化情况,并统计两组并发症发生情况.结果 观察组手术用时及围术期出血量均优于对照组,差异具有统计学意义（P＜0.05）;术后3个月,两组伤椎前缘高度均高于术前,后凸Cobb角均小于术前,差异具有统计学意义（P＜0.05）,两组间伤椎前缘高度和后凸Cobb角比较,差异均无统计学意义（P＞0.05）;观察组并发症发生率为9.68%（3/31）,低于对照组的30.00%（9/30）,差异具有统计学意义（P＜0.05）.结论 后路间接减压复位内固定治疗胸腰椎爆裂骨折合并脊髓神经损伤较后路直接减压复位内固定治疗效果相当,但手术用时短,出血量少,且安全性高.

Objective To investigate the effect of different posterior surgical methods in the treatment of thoracolumbar burst fracture combined with spinal cord injury. Methods A total of 61 cases of patients with thoracolumbar burst fractures combined with spinal cord injury in our hospital were randomly divided into control group （n=30） and observation group （n= 31）, the control group was given posterior direct decompression and internal fixation, and the observation group was treated with posterior indirect decompression and internal fixation, the perioperative bleeding volume, surgical time, frankel nerve function classification and the height of the anterior vertebrae, the change of the kyphosis Cobb angle and complications were observed and compared between the two groups. Results The operation time and perioperative bleeding volume in the obser- vation group were better than those in the control group, the differences were statistically significant （P〈0.05）; the height of the anterior margin of the two groups at 3 months after operation was higher than before operation, the posterior Cobb angle was less than before operation, the differences were statistically significant （P〈0.05）, there was no significant difference in the height of the anterior margin and the posterior Cobb angle of the two groups at 3 months after operation （P〉0.05）; the in- cidence of complications in the observation group （9.68%） was lower than that in the control group （30.00%）, the difference was statistically significant （P〈0.05）. Conclusion The posterior indirect decompression internal fixation and posterior direct decompression internal fixation have equivalent effect on thoracolumbar burst fractures combined with spinal cord injury, but the operation time, bleeding and safety of posterior indirect decompression internal fixation are better.