侧前方入路与后侧入路手术治疗对胸腰段爆裂型骨折合并神经损伤患者神经功能的影响

Effects of anterolateral approach and posterior approach on neurological function of patients with thoracolumbar burst fractures complicated with nerve injury

目的研究侧前方入路与后侧入路手术治疗对胸腰段爆裂型骨折合并神经损伤患者神经功能的影响。方法回顾性分析2016-05—2019-05河南医学高等专科学校附属医院骨科收治的90例胸腰椎爆裂性骨折患者临床资料并根据手术方式不同将分为前路组和后路组,分别采用侧前方入路和后外侧入路进行手术治疗,术后均随访6个月,比较围术期指标、影像学评价、美国脊髓损伤协会(ASIA)、日本矫形外科协会(JOA)下腰痛评分及并发症发生率。结果前路组手术时间和术中出血量均明显高于后路组(P<0.05),术后引流量和平均住院时间差异无统计学意义(P>0.05);术后6个月时,Cobb角明显降低(P<0.05),AVH和SCP明显升高(P<0.05),且前路组Cobb角低于后路组,AVH和SCP均高于后路组,差异有统计学意义(P<0.05);ASIA神经功能分级较术前均明显改善(P<0.05),且前路组ASIA神经功能分级优于后路组,差异有统计学意义(P<0.05);前路组康复情况明显优于后路组(P<0.05),JOA评分优良率分别为82.69%和63.16%(P<0.05);术后并发症发生率分别为11.54%和28.95%(P<0.05)。结论侧前方入路与后侧入路手术均为治疗胸腰段爆裂型骨折合并神经损伤患者的有效方法,其中后路手术有利于减少手术时间和术中出血量,前路手术对维持神经矫形后稳定性和促进神经功能恢复具有明显优势,同时还可减少术后并发症发生。

Objective To study the effects of anterolateral approach and posterior approach on neurological function of patients with thoracolumbar burst fractures complicated with nerve injury.Methods The clinical data of 90 patients with thoracolumbar burst fractures admitted to our hospital from May 2016 to May 2019 were retrospectively analyzed.According to different surgical methods,they were divided into anterior group and posterior group,and they were given anterolateral approach and posterolateral approach for surgical treatment,and they were followed up for 6 months.The perioperative indexes,imaging evaluation,American Spinal Cord Injury Association(ASIA),low back pain score of Japanese Orthopaedic Association(JOA)and incidence rate of complications were compared between the two groups.Results The operative time and intraoperative blood loss in anterior group were significantly higher than those in posterior group(P<0.05),and there were no significant differences in the postoperative drainage volume and mean hospital stay between the two groups(P>0.05).At 6 months after surgery,the Cobb angles in the two groups were significantly decreased(P<0.05)while the AVH and SCP in the two groups were significantly increased(P<0.05),and the Cobb angle in anterior group was lower than that in posterior group while the AVH and SCP were higher than those in posterior group(P<0.05).The ASIA neurological function grading in the two groups was significantly improved compared with that before surgery(P<0.05),and the ASIA neurological function grading in anterior group was better than that in posterior group(P<0.05).The rehabilitation in anterior group was significantly better than that in posterior group(P<0.05).The excellent and good rates of JOA score in the two groups were 82.69%and 63.16%respectively(P<0.05).The incidence rates of postoperative complications in the two groups were 11.54%and 28.95%(P<0.05).Conclusion Anterolateral approach surgery and posterior approach surgery both are effective methods in the treatment of thoracolumbar burst fractures with nerve injury.Posterior surgery is beneficial to reduce the operative time and intraoperative blood loss,and anterior surgery has obvious advantages in maintaining stability of neurological orthopedics and promoting the recovery of neurological function,and can reduce the occurrence of postoperative complications.