不同入路方式减压内固定术治疗合并脊髓受损的胸腰椎爆裂性骨折患者的疗效研究

Effect of decompression internal fixation with different approaches on treating thoracolumbar burst fracture patients complicated with spinal cord injury

目的分析不同入路方式减压内固定术治疗合并脊髓受损的胸腰椎爆裂性骨折患者的疗效。方法选取78例合并脊髓受损的胸腰椎爆裂性骨折患者。根据手术入路方式分为A组40例(前入路组)和B组38例(后入路组)。比较2组患者的一般资料、手术基本情况、手术前后的后凸Cobb角、伤椎高度及Frankel分级情况。结果 A组患者的植骨融合时间较B组显著更短(P<0.05),而手术时间、住院时间及术中出血量均无显著差异(P>0.05)。与术前相比,术后1周2组患者的伤椎高度及后凸Cobb角及术后12个月的Frankel分级情况均显著改善(P<0.05),但同时点2组患者的伤椎高度、后凸Cobb角、Frankel分级均无显著差异(P>0.05)。结论在合并脊髓受损的胸腰椎爆裂性骨折患者的治疗中,前、后入路减压内固定术治疗效果相当,但前入路术的植骨融合时间更短,后凸Cobb角丢失更少。

Objective To analyze the effect of decompression internal fixation with different approaches on treating thoracolumbar burst fracture patients complicated with spinal cord injury.Methods A total of 78 thoracolumbar burst fracture patients with spinal cord injury were selected.According to the different approaches,they were divided into group A（ anterior approach decompression,n = 40） and group B（ posterior approach decompression,n = 38）. The general information,the basic operation situation,the Cobb angle,vertebral height and Frankel grade before and after operation were compared between two groups. Results The bone graft fusion time in group A was significantly less than that in group B（ P〈0. 05）,and the operation time,the hospitalization time and the intra-operative blood loss showed no significant differences between two groups（ P〈0. 05）. The Cobb angle,vertebral height and Frankel grade after operation were better than those before operation in both groups（ P〈0. 05）,but the Cobb angle,vertebral height and Frankel grade at the same time showed no significant differences between two groups（ P〉0. 05）. Conclusion The decompression internal fixation with anterior,posterior approaches can effectively treat thoracolumbar burst fracture patients complicated with spinal cord injury,but for anterior approach,the bone graft fusion time is shorter and the Cobb angle loss is less.