Magerl B 型胸腰椎骨折手术治疗的比较研究  

A comparative study of operative treatments of thoracolumbar fractures of Magerl type B

作　　者：郑圣鼐[1] 姚庆强[1] 王黎明[1] 徐杰[1] 曾逸文[1] 王钢锐[1] 孙达锋[1] 时梦骁[1] 徐燕[1] 

机构地区：[1]南京医科大学附属南京第一医院脊柱外科,210006

出　　处：《中华创伤骨科杂志》2010年第3期221-225,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 通过对比后路间接减压内固定术（POIT）、后路椎板切除减压内固定术（POLT）与前路减压内固定术（ADIT）治疗Magerl B型胸腰椎骨折的临床 结果 ,探讨Magerl B型胸腰椎骨折的治疗要点.方法 2005年11月至2008年1月回顾性分析69例Magerl B型胸腰椎骨折患者资料,其中POIT组23例,POLT组25例,ADIT组21例.3组患者的年龄、性别比、术前伤椎前缘高度比值、伤椎后缘高度比值、Cobb角等比较差异均无统计学意义（P〉0.05）.比较3组患者手术时间、术中术后出血量、术中术后并发症、术后后凸畸形矫正、椎管占位复位及神经损伤恢复程度. 结果 69例患者术后获20～25个月（平均22个月）随访.POIT组、POLT组、ADIT组手术时间分别为（90±15）、（123±30）、（153±30）min 术中出血量分别为（212±25）、（407±47）、（532±147）mL 术后出血引流量分别为（154±11）、（218±27）、（271±53）mL.术后1年POIT组伤椎前、后缘缘高度比值分别为85.2%±4.0%和96.4%±4.0%,均优于POLT组,差异有统计学意义 且POIT组和POLT组术后1年伤椎前、后缘高度值及Cobb与术前比较均有明显改善,差异有统计学意义（P〈0.05）.术后Cobb角恢复优于POLT组和ADIT组,差异均有统计学意义（P〈0.05）.术后1年神经损伤恢复、纠正丢失程度,3组间比较差异无统计学意义（P〉0.05）. 结论 Magerl B型胸腰椎骨折在后纵韧带复合体完整情况下是POIT的适应证 POIT对该型骨折复位效果优于POLT及ADIT,且创伤小、并发症发生率低,但其远期效果需要进一步临床研究.Objective To compare clinical outcomes of posterior open-reduction and indirect-decompression technique （POIT）, posterior open-reduction and laminectomy technique （POLT）, and anterior decompression and internal fixation technique （ADIT） in the treatment of thoracolumbar fractures of Magerl type B. Methods A retrospective study was conducted of the 69 patients who had been treated in our department for thoracolumbar fractures from November 2005 to January 2008. Of them, 23 cases were treated with POIT, 25 with POLT and 21 with ADIT. Comparisons were conducted between the 3 groups in operation time, intra-and pest-operative blood loss, complications, reduction of kyphosis, vertebral channel occupation and neural recovery. Results The patients were followed up from 20 to 25 months, with an average of 22 months. The operation time in POIT group was 90±15 （78 to 119） min, 123±30 （93 to 156） min in POLT group and 153±30（127 to 186）min in A DIT group. In the 3 groups, the average intra-operative blood losses were 212±25 mL, 407±47 mL and 532±147 mL respectively, while the post-operative blood losses 154±11 mL, 218±27 mL and 271±53 mL respectively. Fewer complications happened in the POIT group than in the POLT and ADIT groups. There were no statistical differences in the recovery of nerve injury and the reduction loss between the 3 groups one year after operation. Conclusions POIT may be an appropriate treatment for the thoracolumbar fracture of Magerl type B when the posterior ligaments are not injured. POIT may have better clinical outcomes than POLT and ADIT, but its long-term effects need further investigation.

关 键 词：脊柱骨折 胸椎 腰椎 骨折固定术 内 病例对照研究 

分 类 号：R686[医药卫生—骨科学]