评价后路微创治疗胸腰段脊柱骨折并脊髓损伤的近远期疗效

Evaluation of Short - term and Long - term Efficacy of Posterior Minimally Invasive Therapy in the Treatment of Thoracolumbar Spine Fractures with Spinal Cord Injury

目的:探讨后路微创治疗胸腰段脊柱骨折并脊髓损伤的近远期疗效.方法:回顾性分析我院2014年3月-2018年5月收治的136例胸腰段脊柱骨折并脊髓损伤患者的临床资料,以手术方式不同分为前路组(60例)和后路组(76例),前路组采用前路微创治疗,后路组采用后路微创治疗.比较2组的术中出血量、手术时间、住院时间等相关手术指标,于手术前及术后3个月比较2组的伤椎高度及伤椎Cobb's角、触觉及运动评分、视觉疼痛模拟评分(VAS),随访3个月,比较2组的并发症及复发情况.结果:后路组的术中出血量、手术时间及住院时间均显著短于前路组(P<0.05);手术后3个月,2组的伤椎高度、伤椎Cobb's角均有增大,但2组比较无显著差异(P>0.05);2组的触觉、运动评分均有升高,VAS评分均有降低,但2组的触觉、运动评分比较无显著差异(P>0.05),后路组的VAS评分显著低于前路组(P<0.05);2组均无明显并发症及复发情况.结论:相较于前路手术方式,后路微创治疗具有创伤小、操作简单、出血量少等优势,且其与前路手术方式一样具有良好的临床效果.

Objective: To investigate the short - term and long - term efficacy of posterior minimally invasive therapy in the treatment of thoracolumbar spine fractures with spinal cord injury. Methods: The clinical data of 136 patients with thoracolumbar spine fractures and spinal cord injury admitted to our hospital from March 2014 to May 2018 were retrospectively analyzed. According to the surgical methods, they were divided into anterior group (60 cases) and posterior group (76 cases). Anterior group was treated with anterior minimally invasive therapy, and posterior group was treated with posterior minimally invasive therapy. The related surgical indexes of intraoperative blood loss, operative time and hospital stay were compared between the two groups. The height of injured vertebrae and Cobb's angle of injured vertebrae, tactile score and moter score and visual pain analogue scale ( VAS) score were compared between the two groups before operation and at 3 months after operation. At 3 months of follow - up, the complications and recurrence were compared between the two groups. Results: The intraoperative blood loss, operative time and hospital stay in posterior group were significantly shorter than those in anterior group ( P <0. 05 ). At 3 months after operation, the height of injured vertebrae and Cobb's angle of injured vertebrae were increased, but there were no significant differences between the two groups ( P > 0. 05 ). The tactile score and motor score in the two groups were increased while the VAS score was decreased, but there were no significant differences in tactile score and motor score between the two groups (P >0. 05), and the VAS score in posterior group was significantly lower than that in anterior group ( P <0. 05 ). There were no significant complications and recurrence in the two groups. Conclusions: Compared with anterior approach, posterior minimally invasive therapy has the advantages of small trauma, simple operation and little blood loss, and it has the same good clinical effect as anterior approach.