经峡部开窗椎管减压术与椎板切除减压术治疗胸腰椎爆裂骨折的疗效比较

Effect comparison of the transisthmic fenestration decompression and laminectomy decompression in the treat⁃ment of thoracolumbar burst fractures

目的探讨经峡部开窗椎管减压术与椎板切除减压术治疗胸腰椎爆裂骨折的疗效比较。方法选取82例胸腰椎爆裂骨折患者,根据随机数字表分为实验组和对照组,每组41例。对照组行椎板切除减压术治疗,实验组行经峡部开窗椎管减压术治疗。比较两组患者围术期评价指标、住院时间、椎前缘高度比(RAVA)、Cobb角、椎管侵占率、疼痛、神经功能及并发症情况。结果实验组患者术中出血量、术后24 h引流管引流量均低于对照组,住院时间短于对照组,差异均有统计学意义(t分别=12.29、14.82、3.04,P均<0.05)。两组术后3 d RAVA、Cobb角、椎管侵占率均较术前明显改善(t分别=14.52、21.37、37.91、17.25、11.76、22.19,P均<0.05),但两组间比较,差异均无统计学意义(t分别=0.47、0.61、0.75,P均>0.05)。两组术后7 d、术后1年VAS评分均较术前明显降低,且实验组患者术后1年VAS评分低于对照组(t分别=7.15、15.38、8.35、17.54、3.84,P均<0.05)。两组患者术后1年美国脊髓损伤协会(ASIA)评分分级均较术前明显改善(χ2分别=6.38、4.97,P均<0.05),但两组术后1年ASIA评分分级比较,差异无统计学意义(χ2=0.83,P>0.05)。两组患者随访期间并发症发生率比较,差异无统计学意义(χ2=0.41,P>0.05)。结论后路手术方式在胸腰椎爆裂骨折患者骨折复位、神经功能恢复方面疗效确切,其中经峡部开窗椎管减压术能不仅能达到椎板切除减压术相似的效果,且在减少术中出血量、术后引流量、缩短住院时间,改善远期疼痛等方面效果更明显,安全可靠。

Objective To compare the effect of transisthmic fenestration decompression and laminectomy decompres-sion in the treatment of thoracolumbar burst fractures.Methods A total of 82 patients with thoracolumbar burst fracture were randomly divided into experimental group and control group,with 41 cases in each group.The control group was treated with laminectomy decompression,and the experimental group was treated with transisthmic fenestration decompres-sion.The perioperative evaluation indexes,hospital stay,anterior vertebral height ratio(RAVA),Cobb angle,spinal canal occupation rate,pain,neurological function and complications were compared between the two groups.Results The blood loss during operation and the drainage volume of drainage tube 24 hours after operation in the experimental group were lower than those in the control group,and the hospital stay was shorter than that in the control group(t=12.29,14.82,3.04,P<0.05).The RAVA,Cobb angle,and spinal canal occupation rate were significantly improved in the two groups at 3 days after surgery(t=14.52,21.37,37.91,17.25,11.76,22.19,P<0.05),but there was no statistical signif-icance between the two groups(t=0.47,0.61,0.75,P>0.05).The VAS scores of the two groups at 7 days and 1 year after the operation were significantly lower than that of the preoperative and the VAS scores of the experimental group were lower than those of the control group(t=7.15,15.38,8.35,17.54,3.84,P<0.05).The ASIA scores scale of the two groups of patients at 1 year after operation were significant-ly improved compared with preoperatively(χ2=6.38,4.97,P<0.05),but there was no statistically signif-icant difference in the ASIA scores scale of the two groups at 1 year after surgery(χ2=0.83,P>0.05).There was no significant difference in the incidence of complications between the two groups during the follow-up period(χ2=0.41,P>0.05). Conclusion The posterior approach has a defi-nite effect in fracture reduction and nerve function recovery in patients with thoracolumbar burst fractures.Among them, the transishmic fenestration decompression through the isthmus can not only achieve the similar effects of laminectomy decompression,but also reduce intraoperative bleeding.The effect is more obvious in terms of volume,postoperative drain-age, shortening the length of hospitalization,and improving long-term pain.It is safe and reliable.