胸腰段爆裂骨折致不全瘫患者前后手术入路的疗效分析  

The efficacy of the anterior versus posterior approaches for treatment of incomplete paraplegia after thoracolumbar burst fracture

作　　者：吕荼[1] 韩亚新[1] 朱佳俊[1] 张国栋[1] 梁栋[1] 屠冠军[1] 

机构地区：[1]中国医科大学附属第一医院骨科,沈阳110001

出　　处：《中国矫形外科杂志》2011年第24期2045-2048,共4页Orthopedic Journal of China

摘　　要：[目的]探讨胸腰段爆裂骨折致不全瘫患者前、后手术入路的疗效。[方法]回顾性分析2007年1月～2010年1月手术治疗单节段的胸腰段爆裂骨折不全瘫患者共62例,前路手术15例,后路手术47例,按照美国脊柱创伤研究组提出的胸腰椎损伤的分类和严重性评分(thoracolumbar injury classification and severity score,TLICS),分别对各组病例进行评分。评定脊髓神经功能恢复情况采用根据JOA改良的神经功能评分表。影像学X线检查胸腰段后凸Cobb角的手术矫正情况和随访丢失情况,应用SPSS 17.0软件进行统计学分析。[结果]39例随访12～36个月,平均27个月。所有患者术后神经损伤症状较术前减轻,随访神经功能的恢复率前路组好于后路组(P=0.002)。所有骨折复位效果满意。后路组比前路组术后Cobb角丢失角度大(P<0.05)。[结论]2种手术方式都能对胸腰椎爆裂骨折致不全瘫患者进行有效的救治,前路手术在重建脊柱稳定性、术后神经功能恢复方面更加优越,并发症发生概率小。[Objective]To analyze the efficacy of anterior versus posterior surgieal treatment of patients with incomplete paraplegia after thoracolumbar burst fracture [Method]A retrospective review of surgieal treatment of sixty-two patients was carried out.Fifteen patients received anterior and 47 received posterior surgeries.Neurological status was assessed using a modified JOA scoring system.Cobb＇s angle for surgical correction was determined on radiograms.Statistical analysis was done using software SPSS17.0. [Result]Thirty-nine patients were followed-up form 12 to 36 months,with an average of 27 months.All the patients with incomplete paraplegia after thoracolumbar burst fracture injury had no worsened symptoms.Neurological recovery in anterior group was better than in the posterior group（P=0.002）.The angle of loss in the posterior group was more than in the anterior group（P〈0.05）. [Conclusion]It is effective for patients with incomplete paraplegia after thoracolumbar burst fracture to be treated by both approaches.However anterior surgery is more favorable.

关 键 词：胸腰段骨折 爆裂骨折 前路手术 后路手术 

分 类 号：R687.3[医药卫生—骨科学]