颈椎骨折合并颈髓损伤患者前、后入路选择及手术效果比较

A Study on the Selection of the Anterior and Posterior Approach and the Comparison of Their Surgical Results in Patients with Cervical Spine Fracture Complicated with Cervical Spinal Cord Injury

目的比较颈椎骨折合并颈髓损伤患者前、后入路手术方式的选择及手术效果。方法选取2014年1月至2017年1月绵阳市中心医院收治的颈椎骨折合并颈髓损伤患者80例为研究对象,采用随机数字表法分为试验组、对照组各40例。试验组行经前后路联合复位减压植骨融合钢板内固定术;对照组实施经前路复位减压植骨融合钢板内固定术,记录两组手术时间、术中出血量、住院时间、植骨融合时间等手术相关指标,比较两组术前及术后6个月Cobb角、椎体间滑移距离和日本矫形外科协会评分(JOA),采用Frankel分级标准评价两组手术前后神经功能状态,并记录并发症发生情况。结果试验组手术时间(197.2±25.3)min较对照组明显延长,术中出血量(359.20±45.68)mL高于对照组;试验组住院时间(7.76±1.33)d、植骨融合时间(11.23±0.45)周,均短于对照组,差异有统计学意义(P<0.05);试验组术后6个月Cobb角(6.42±1.03)°、椎体间滑移距离(2.56±0.17)mm明显小于对照组,而JOA评分(15.28±1.26)分较对照组高,差异有统计学意义(P<0.05);试验组术后6个月Frankel神经功能分级优于对照组(Z=9.726,P<0.05);两组术后6个月并发症发生率分别为7.50%、12.50%,两组比较差异无统计学意义(P>0.05)。结论颈椎骨折合并颈髓损伤采用前后路联合方式进行手术稳定性更强,术后近期颈椎解剖结构、脊髓神经功能恢复良好,不会增加并发症,但手术操作难度大,手术时间延长,会增加出血量,应在严格把握适应症情况下合理选择手术入路。

Objective To study the selection of the anterior and posterior approach and compare the results surgical in patients with cervical fracture complicated with cervical spinal cord injury. Methods 80 cases of patients with cervical spine fracture complicated with cervical spinal cord injury treated in Mianyang Central Hospital from January of 2014 to January of 2017 were selected as the research objects and divided into the experiment group and the control group according to the random number table, and each group consisted of 40 cases. The experiment group was treated with the combination of anterior and posterior approaches of cervical decompression and bone graft fusion with internal fixation, while the control group was given the anterior cervical decompression and bone graft fusion with internal fixation. The related surgical indicators including the operative time, intraoperative blood loss, hospital stays and bone graft fusion time were recorded in the two groups. The two groups were compared before and after operation in terms of the Cobb angle, intervertebral slippage distance and Japanese Orthopedic Association （JOA） score. The Frankel classification was used to assess the neurological status of the two groups before and after operation, and the complications were recorded. Results The operative time of the experiment group was （197.2±25.3）min, which was significantly longer than that of the control group （P〈0.05）. The intraoperative blood loss of the experiment group was （359.20±45.68）ml, which was significantly higher than that of the control group （P〈0.05）. The hospital stays and the bone graft fusion time in the experiment group were （7.76±1.33）d and （11.23 ±0.45）weeks respectively, and they were significantly shorter than those in the control group （P〈 0.05）. The Cobb angle and the intervertebral slippage distance in the experiment group were （6. 42±1.03）% and （2.56±0.17） mm respectively after 6 months of operation, and they were significantly smaller than those in the control group while the JOA score in the experiment group was （15.28± 1.26） points, which was significantly higher than that in the control group （P〈0.05）. The Frankel nerve function grade of the experiment group was significantly better than that of the control group （Z= 9. 726, P〈0.05）. The incidences of complications after 6 months of operation were 7.50% in the experiment group and 12.50% in the control group, and there was no significant differences between the two groups （P〉0.05）. Conclusion The combination of anterior and posterior approaches makes the surgical stability much stronger with good postoperative cervical anatomy and spinal nerve function recovery and without the increase of complications in the treatment of cervical spine fracture complicated with cervical spinal cord injury. Meanwhile, the approach should be selected under the strict control of indications as the operation is difficult to handle owing to the longer operative time and increased bleeding loss.