胸腰椎爆裂骨折致脊髓神经损伤不同术式对照研究

Controlled study of different posterior surgical procedures in treatment of spinal nerve injury caused by thoracolumbar burst fracture

目的对比后路不同手术方式治疗胸腰椎爆裂骨折合并脊髓神经损伤的临床疗效。方法选取2015-08—2016-10信阳市中心医院收治的胸腰椎爆裂骨折合并脊髓神经损伤患者96例,根据随机数表法分为2组各48例。对照组采用间接复位内固定,观察组实施椎板切除内固定。对比2组神经功能改善情况及术前、术后Cobb’s角与伤椎前缘高度压缩比、手术时间及术中出血量。结果观察组术后神经功能改善情况与对照组相比,差异无统计学意义(P>0.05);观察组术后Cobb’s角与伤椎前缘高度压缩比与对照组比较差异无统计学意义(P>0.05);观察手术时间(160.39±32.45)min、出血量(681.64±75.39)mL,均明显多于对照组的(126.05±30.18)min、(320.15±53.62)mL,差异有统计学意义(P<0.05)。结论后路间接复位内固定与椎板切除内固定治疗胸腰椎爆裂骨折合并脊髓神经损伤疗效相近,间接复位内固定在手术时间与术中出血量方面优势更明显。

Objective To compare the clinical efficacy of different posterior surgical procedures in treatment of thoracolumbar burst fracture(TLBF)combined with spinal nerve injury.Methods Ninety-six patients with TLBF combined with spinal nerve injury in Xinyang Central Hospital from August 2015 to October 2016 were selected,and they were divided into two groups by random number table,48 cases in each group.Control group was given indirect reduction and internal fixation,while observation group was given laminectomy and internal fixation.The improvement of nerve function,preoperative and postoperative Cobb's angle,anterior vertebral height compression ratio,operation time,intra-operative bleeding volume were compared between the two groups.Results The postoperative improvement of nerve function in observation group was not statistically different compared with control group(P >0.05).The postoperative Cobb's angle and anterior vertebral height compression ratio in observation group were similar to those in control group,there was no statistical difference(P>0.05).The operation time and intra-operative bleeding volume in observation group was(160.39±32.45)min,(681.64±75.39)mL,respectively,which was more than(126.05±30.18)min,(320.15±53.62)mL in control group,there were statistical differences(P<0.05).Conclusion The efficacy of posterior indirect reduction and internal fixation is similar to that of laminectomy and internal fixation,but indirect reduction and internal fixation has more advantages in operation time and intra-operative bleeding volume.