评分分级法指导胸腰椎爆裂骨折治疗的临床意义及评价  

Clinical significance and assessment of evaluating grade method in guiding treatment of thoracolumbar burst fracture

作　　者：潘海涛[1] 郑启新[1] 胡军[2] 

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022 [2]湖北省十堰市太和医院创伤骨科

出　　处：《临床外科杂志》2008年第4期266-268,共3页Journal of Clinical Surgery

摘　　要：目的回顾性分析评分分级法指导胸腰椎爆裂骨折治疗的远期疗效并评价该分级法的临床价值。方法选择1995年1月至2001年6月采用评分分级法指导治疗胸腰椎爆裂骨折138例,根据日本骨科学会评分系统(JOA评分)分析评分分级法指导治疗的远期疗效。结果全部病例随访5～10年,平均8.8年。38例Ⅰ级患者采取保守治疗,治疗后JOA评分平均改善率(72.4±5.9)%,优良率94.7%;57例Ⅱ级患者和43例Ⅲ级患者采取手术治疗,术后JOA评分平均改善率分别为(48.2±8.3)%和(25.6±4.2)%,优良率分别为61.4%和27.9%,三组间差异有统计学意义(P<0.01)。采取前路手术、后路手术或前后路联合手术患者的JOA评分平均改善率和优良率差异无统计学意义(P>0.05)。结论评分分级法对胸腰椎爆裂骨折患者损伤严重度的判定、治疗方式的选择、远期疗效及预后的评估具有重要价值。Objective To retrospectively analyze the long - term clinical outcomes of evaluating grade method in guiding treatment of thoracolumbar burst fracture and assess its clinical values. Methods 138 cases of thoracolumbar burst fracture were all graded by the means of evaluating grade method and then treated conservatively or surgically from Jan. 1995 to Jun. 2001. The outcomes were assessed according to JOA scale system. Results All cases were followed up for 5 to 10 years （ mean 8.8 years）. Thirty - eight eases of grade I were treated conservatively and average recovery rate of JOA scale after treatment was （72.4±5.9 ）% and percentage of receiving＂ excellent＂or＂ good＂ratings was 94.7%. Fifty - seven eases of grade Ⅱ and 43 eases of grade Ⅲ were operated and postoperative average recovery rate of JOA scale was （48.2±8.3 ） % and （ 25.6±4.2） % respectively, and percentage of receiving＂ exeellent＂or＂good＂ratings were 61.4% and 27.9% respectively. There was significant difference among the groups （ P 〈 0.01 ）. But among groups of anterior approach, posterior approach or combined approach postoperative average recovery rate of JOA scale and percentage of receiving＂ excellent＂ or＂ good＂ ratings had no significant differences （ P 〉 0.05 ）, Conclusion Evaluating grade method has important values in assessing the injury severity, selecting treatment methods, analyzing the long - term clinical outcomes and evaluating the prognosis.

关 键 词：评分分级法 胸腰椎 爆裂骨折 JOA评分 

分 类 号：R683.2[医药卫生—骨科学]