后路间接减压内固定术与前路减压固定治疗Magerl B型胸腰椎骨折的比较研究  

Clinical Research on Posterior Indirect-decompression Technique and Anterior Decompression Technique in Treatment of Thoracic or Lumbar Vertebral Fracture in 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,江苏省南京市210006

出　　处：《中国骨与关节损伤杂志》2010年第11期965-968,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的对比后路间接减压内固定术(POIT)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,并分析POIT技术的要点。方法收治Magerl B型胸腰椎骨折44例,其中POIT组23例,ADIT组21例。记录手术时间、术中术后出血量、术中术后并发症、术后脊柱后凸畸形矫正、椎管占位复位及神经损伤恢复程度。结果随访20～25个月。POIT与ADIT比较,手术时间(90±15)mim、(153±30)min,P<0.05;术中出血量(212±25)ml、(532±147)ml,P<0.05;术后出血引流量(154±11)ml、(271±53)ml,P<0.05;术中术后早期并发症发生率、远期残留腰痛的发生率POIT组优于ADIT组;POIT组术后Cobb角矫正程度优于ADIT组,术后1年两组神经损伤恢复、矫正丢失程度无显著差异。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适应证;POIT对该型骨折复位效果优于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 investigate the feasibility and clinical outcome of posterior open-reduction and indirect-decompression tech-nique（POIT） in the treatment of thoracic or lumbar vertebral fracture in Magerl type B,and analyze the two operation methods： posterior open-reduction and indirect-decompression technique and anterior decompression and internal fixation technique（ADIT）.Methods Forty four cases were divided into two groups randomly.In POIT group,23 cases were operated.In ADIT group,21 cases were treated.Time of operation,the intra-and post-operative blood loss,the rate of complications were recorded.The reduction of kyphosis,vertebral tube oc-cupying place,and the recovery of nerve injury were recorded.Results The patients were followed up from 20 to 25 months with an av-erage of 22 months.The time of operation in group of POIT was 90±15（78~119）min,while in group of ADIT was 153±30（127～186）min,P 0.05,the intra-operative blood loss in these is 212±25ml,532±147ml,P 0.05,the post-operative blood loss was 154±11ml,271±53ml,P 0.05.Less complications happened in the POIT group than in the ADIT group.Less complications happened in the POIT group than in the ADIT group.There were no statistical difference in the recovery of nerve injury,the loss of reduction between the two group one year after operation.Conclusion POIT technique may be an appropriate technique to treat the thoracic or lumbar vertebral fracture in Magerl B type with the posterior ligaments uninjuryed,and the outcome of the POIT operation is better than the ADIT operation.But its long-term effects are worthy of further clinical research.

关 键 词：椎体骨折 间接减压 前路手术 内固定 

分 类 号：R684[医药卫生—骨科学]