经后外单侧入路手术治疗胸腰椎爆裂性骨折的临床疗效观察

Clinical Observation of the Treatment of Thoracolumbar Burst Fractures with Posterior Unilateral Approach

目的探讨经后外单侧入路椎体次全切、植骨融合、钉棒固定术治疗胸腰椎爆裂性骨折的临床疗效。方法选取我院自2014年1月至2016年3月收治41例Denis B型胸腰椎爆裂性骨折患者,按照采取的手术方式不同分为后外单侧入路组(23例)和侧前方入路组(18例),后外单侧入路组采用经后外单侧入路椎体次全切植骨融合钉棒固定术,侧前方入路组采用侧前方入路椎体次全切植骨融合钉板固定。并比较两组患者手术指标、术后神经功能恢复情况、胸腰椎后凸角(Cobb角)恢复情况、植骨融合情况,采用日本矫形外科协会(JOA)制定的下腰痛疾患评分法进行临床疗效评价。结果(1)两组患者手术时间、术中出血量、术后引流量比较无统计学差异(P>0.05);(2)Cobb角恢复情况:两组患者术后1周Cobb角与术前比较改善明显,差异具有统计学意义(P<0.05);术后1年后外单侧入路组Cobb角改善情况明显优于侧前方入路组,差异具有统计学意义(P<0.05);(3)神经功能恢复情况:术后1年两组患者ASIA分级明显优于术前,差异具有统计学意义(P<0.05);组间比较差异无统计学意义(P>0.05);(4)疗效评价:后外单侧入路组临床总有效率为95.65%,侧前方入路组临床总有效率为72.22%,差异具有统计学意义(P<0.05)。结论在治疗胸腰椎爆裂性骨折中,经后外单侧入路椎体次全切植骨融合钉棒固定与侧前方入路椎体次全切植骨融合钉板固定相比疗效显著,术后胸腰椎后凸角改善良好,值得临床推广。

Objective To explore the clinical effects of posterior unilateral approach in subtotal ver- tebrectomy, bone graft fusion and pedicle screw fixation for the treatment of thoracolumbar burst fractures. Methods From January 2014 to March 2016, 41 cases of Denis B thoracolumbar burst fractures were select- ed. According to the different surgical methods, the patients were divided into two groups. The posterior unilat- eral approach group （group A, n = 23） was treated by the posterior unilateral approach, subtotal vertebrecto- my, bone graft fusion and pedicle screw fixation. The lateral anterior approach group （group B, n = 18） was treated with the lateral anterior approach. The clinical results of the two groups were compared retrospec- tively. Results （~）There was no significant difference in operative time, the amount of bleedingand postoperative drainage between the two groups （P 〉 0.05 ）. （~） Both the two groups after 1 week got the Cobb angle improved significantly comparing with preoperative one （ P 〈 O. 05 ） , and the 1- year post- operative Cobb angle of group A was lower than that of group B （ P 〈 O. 05 ）. （~）In both groups, the postop- erative ASIA grading was better than before （ P 〈 0.05 ） ; But there was no significant difference between the two groups （ P 〉 0.05 ）. （~The clinical total effective rate was 95.65 % of group A, which was signifi- cantly better than 72.22% of group B （P 〈 O. 05）. Conclusion In the treatment of thoracolumbar burst fractures, it is proved to be efficacy of the posterior unilateral approach in the treatment of vertebraX subtotal resection, bone fusion and pedicle screw fixation, with better postoperative Cobb angle improve- ment. It is worthy of clinical promotion.