手术干预时机对胸腰段骨折合并脊髓损伤患者预后的影响研究

Effect of surgical intervention timing on prognosis of patients with thoracolumbar fracture complicated with spinal cord injury

目的 评估早期和晚期减压固定对胸腰段骨折合并脊髓损伤预后的改善情况。方法 对2010年1月至2018年12月,T_(11)~L_(2)发生创伤性脊髓损伤的320例患者进行回顾性分析,男227例,女93例,平均年龄(32.55±11.43)岁。对伤后24 h内接受早期手术(组1,n=145)、24~72 h内接受手术(组2,n=46)和伤后72h以上接受手术(组3,n=34)的患者进行分组分析。比较术后1年时Frankel分级的变化。结果 组1有81例、组2有46例、组3有34例患者的Frankel分级改善≥1级(P<0.001)。组1有33例、组2有13例、组3有11例患者的Frankel分级改善≥2级(P=0.070)。Logistic回归分析显示,早期手术和初始脊髓损伤程度与神经功能预后显著相关(P<0.001)。结论 手术减压越早预后越好,72h内为有效手术减压的窗口期,在此期间,手术减压可能对不完全脊髓损伤具有保护作用。

Objective To evaluate the effect of early or late decompression and fixation on the prognosis of thoracolumbar fracture with spinal cord injury.Methods From January 2010 to December 2018,320 patients with traumatic spinal cord injury of T_(11)-L_(2) were analyzed retrospectively.There were 227 males and 93 females with an average age of(32.55 ± 11.43) years.The patients who received early operation within 24 hours(group 1,n=145),24-72 hours(group 2,n=46) and more than 72 hours after injury(group 3,n=34) were divided into groups.The changes of Frankel grade at 1 year after operation were compared.Results Frankel grade improved≥1 for 81 patients in group 1,46 patients in group 2 and 34 patients in group 3(P<0.001).Frankel grade improved ≥2 for 33 patients in group 1,13 patients in group 2 and 11 patients in group 3.Logistic regression analysis showed that early operation and the degree of initial spinal cord injury were significantly correlated with the prognosis of neurological functions(P<0.001).Conclusions Earlier surgical decompression brings better prognosis.The window period of effective surgical decompression is within 72 hours,during which surgical decompression may have a protective effect on incomplete spinal cord injury.