不同手术方法治疗胸腰段椎体爆裂骨折合并神经损伤的效果分析

Surgical treatment of thoracolumbar burst fracture with nerve injury

目的探究胸腰段椎体爆裂骨折合并神经损伤采用不同手术方法治疗的效果。方法选择2014年1月~2018年12月41例胸腰段椎体爆裂性骨折合并神经损伤患者,根据手术治疗方法不同分为对照组和试验组,前者20例,给予前外侧入路植骨内固定术治疗,试验组21例,给予后入路减压联合复位椎弓根钉内固定术治疗,比较两组手术治疗指标、疼痛评分和胸腰椎恢复情况。结果试验组手术时间(101.21±8.15)min短于对照组(172.34±9.84)min(t=25.259,P<0.001);术中出血量(512.34±21.45)mL少于对照组(731.66±23.12)mL(t=31.507,P<0.001);两组术前视觉模拟评分(VAS)组间比较差异无统计学意义(P>0.05),但术后两组均较术前降低,组间比较试验组(2.97±1.05)分更低(t=3.128,P<0.001);两组术前前缘高度、后缘高度、后凸Cobb角组间比较差异无统计学意义(P>0.05),术后两组上述指标均有改善,对照组前缘高度(79.32±3.76)%、后缘高度(91.01±2.55)%均较术前升高,后凸Cobb角(6.22±1.41)°减少,且均优于试验组(t值分别为8.196、7.480、7.570,P<0.001)。结论在胸腰段椎体爆裂性骨折合并神经损伤患者治疗中,后入路手术创伤较小,手术风险较低,而前入路更利于胸腰椎稳定性恢复,促进临床症状改善,应根据患者实际情况合理选择手术入路。

Objective To explore the effects of different surgical methods on thoracolumbar vertebral burst fractures and nerve injuries.Methods A total of 41 patients with thoracolumbar vertebral burst fractures and nerve injuries were recruited from January 2014 to December 2018.They were divided into the control group and the experimental group according to different surgical treatment methods.20 cases were given anterior-lateral approach to bone grafting as controls;in the treatment group,21 patients were treated with postoperative decompression combined with pedicle screw internal fixation.The surgical treatment indexes,pain scores,and thoracolumbar spine recovery were compared between these two groups.Results The operation time of the treatment group(101.21±8.15)min was shorter than that of the control group(172.34±9.84)min(t=25.259,P<0.001).The intraoperative blood loss(512.34±21.45)mL was less than the control group(731.66±23.12)mL(t=31.507,P<0.001);there was no significant difference between the two groups in preoperative visual analogue scale(VAS),P>0.05,but the postoperative group was lower than the preoperative group.The comparison test group(2.97±1.05)scores were lower(t=3.128,P<0.001).There was no significant difference between the two groups in terms of preoperative margin height,posterior margin height and kyphosis Cobb angle group,P>0.05.The above indexes of the two groups were improved after operation.The height of the control group(79.32±3.76)%and the height of the posterior margin(91.01±2.55)%were higher than those before the operation,and the kyphosis Cobb angle(6.22±1.41)°decreased,better than the test group(t=8.196,7.480,7.570,P<0.001).Conclusion In the treatment of patients with thoracolumbar vertebral burst fractures and neurological injuries,the posterior approach has less trauma and lower surgical risk,and the anterior approach is more conducive to the restoration of thoracolumbar spine stability and promotes improvement of clinical symptoms.Appropriate surgical approach should be chosen depending on situations.