颈椎前路与后路减压复位融合术治疗下颈椎骨折伴脊髓损伤的对照研究

Comparative Study of Anterior and Posterior Decompression,Reduction and Fusion in the Treatment of Lower Cervical Fracture with Spinal Cord Injury

【目的】比较颈椎前路与颈椎后路减压复位融合术治疗下颈椎骨折伴脊髓损伤的临床疗效。【方法】选取2013年10月至2018年10月于本院收治的62例下颈椎骨折伴脊髓损伤的患者为研究对象,按随机数字表法分为对照组和观察组,其中对照组行后路减压复位融合内固定术治疗,观察组行前路减压复位融合内固定术治疗。术后对两组患者均进行为期1年的随访,观察两组患者手术时间、术中出血量、创口直径、住院时间、椎体复位情况、神经功能恢复等情况,并记录两组患者随访期间并发症发生率。【结果】术后两组患者均获得为期1年的随访,无失访者。观察组手术时间、术中出血量、创口直径、住院时间均少于对照组(P<0.05);末次随访时两组患者平均Cobb角及椎体间滑移距离均降低,JOA评分提高,且与对照组相比,观察组平均Cobb角及椎体间滑移距离降低JOA评分提高更显著(P<0.05);随访期间观察组并发症总发生率低于对照组(P<0.05)。【结论】采用前路减压复位融合内固定术治疗下颈椎骨折伴脊髓损伤可有效提高临床效果,有利于促进颈椎解剖结构恢复。

【Objective】To compare the clinical effects of anterior and posterior cervical decompression,reduction and fusion in the treatment of lower cervical fracture with spinal cord injury.【Methods】A total of 62 patients with lower cervical fracture with spinal cord injury treated in our hospital from October 2013 to October 2018 was randomly divided into control group and observation group.The control group was treated with posterior decompression,reduction,fusion and internal fixation,and the observation group was treated with anterior decompression,reduction,fusion and internal fixation.The patients in both groups were followed up for one year.The operation time,intraoperative bleeding,wound diameter,hospital stay,vertebral reduction and neurological recovery were observed,and the incidence of complications during the follow-up were recorded.【Results】The patients in both groups were followed up for 1 year,and there was no loss of follow-up.The operation time,intraoperative bleeding,wound diameter and hospital stay in the observation group were less than those in the control group(P<0.05);At the last follow-up,the average Cobb angle and inter vertebral slip distance decreased and JOA score increased in the two groups.Compared with the control group,the average Cobb angle and inter vertebral slip distance decreased and JOA score increased more significantly in the observation group(P<0.05);The total incidence of complications in the observation group was lower than that in the control group(P<0.05).【Conclusion】Anterior decompression,reduction,fusion and internal fixation in the treatment of lower cervical fracture with spinal cord injury can effectively improve the clinical effect and promote the recovery of cervical anatomical structure.