不同手术时机对胸腰椎骨折伴完全性脊髓损伤疗效的影响

Impact of different surgical timing on the efficacy of thoracolumbar fracture with complete spinal cord injury

目的探讨不同手术时机对胸腰椎骨折伴完全性脊髓损伤疗效的影响。方法48例胸腰椎骨折伴完全性脊髓损伤患者,按照手术时机不同分为A组(29例)和B组(19例)。A组患者伤后24 h内行急诊手术治疗,B组患者伤后3~5 d行手术治疗。比较两组患者手术时间、术中出血量、术后神经功能恢复情况。结果A组患者手术时间(191.6±35.1)min长于B组的(156.4±23.6)min,术中出血量(968.5±114.3)ml多于B组的(468.8±85.8)ml,差异均具有统计学意义(P<0.05)。48例患者均得到随访,随访时间13~23个月,平均随访时间18个月。所有患者植骨均融合,内固定位置良好,无松动、断裂情况。末次随访时,A组有4例由术前的A级恢复为B级,好转率为13.8%(4/29);B组有2例由术前的A级恢复为B级,好转率为10.5%(2/19)。两组患者术后神经功能好转率比较差异无统计学意义(P>0.05)。结论对于胸腰椎骨折伴完全性脊髓损伤患者,早期手术会增加术中出血量,延长手术时间,增加手术风险,且对于术后神经功能恢复情况无显著效果,因此需先行对症支持治疗、处理基础疾病、改善一般情况后,再行手术治疗。

Objective To discuss the impact of different surgical timing on the efficacy of thoracolumbar fracture with complete spinal cord injury.Methods A total of 48 cases of thoracolumbar fracture with complete spinal cord injury were divided into group A(29 cases)and group B(19 cases)according to different surgical timing.Patients in group A received emergency surgical treatment within 24 h after injury,and patients in group B received surgical treatment at 3-5 d after injury.The operative time,intraoperative blood loss and postoperative neurological function recovery were compared between the two groups.Results The operative time of(191.6±35.1)min in group A was longer than that of(156.4±23.6)min in group B,and the intraoperative blood loss of(968.5±114.3)ml was higher than that of(468.8±85.8)ml in group B.The differences were statistically significant(P<0.05).All 48 patients were followed up for 13-23 months,with an average of 18 months.All patients had bone grafting fusion,with good internal fixation position and no looseness or breakage.At the last followup,4 cases in group A recovered from preoperative grade A to grade B,the improvement rate was 13.8%(4/29);in group B,2 patients recovered from grade A to grade B,and the improvement rate was 10.5%(2/19).There was no statistically significant difference in the improvement rate of postoperative neurological function between the two groups(P>0.05).Conclusion For patients with complete spinal cord injury,early surgery will increase intraoperative blood loss,prolong the operative time,increase the risk of surgery,and has no significant effect on postoperative neurological recovery.Symptomatic and supportive treatment,treatment of basic diseases and improvement of general conditions should be done before surgical treatment.