胸腰段骨折手术决策流程的量化及临床应用  

Quantification of Operation Decision-Making in Thoracolumbar Fracture Patients and Clinical Application

作　　者：王方永[1,2] 洪毅[1,2] 张军卫[1,2] 白金柱[1,2] 唐和虎[1,2] 关骅[1,2] 

机构地区：[1]中国康复研究中心脊柱外科 [2]首都医科大学康复医学院,北京100068

出　　处：《实用骨科杂志》2012年第6期481-484,共4页Journal of Practical Orthopaedics

基　　金：首都医学发展基金(2009-2096)

摘　　要：目的评估一种量化的胸腰段骨折手术决策系统在临床实践中的初步应用效果。方法首先根据文献报道和临床体会,选取国际公认的相关分类和评分方法,构建胸腰段骨折手术决策量化评估体系。使用该评估体系对2010年1月至2011年1月入住我科的胸腰段骨折患者,术前术后资料完整者共48例进行研究。首先根据患者术前资料,使用该决策系统评估患者的手术指证、手术入路和手术固定节段。然后与患者实际接受的手术情况进行对比分析。与评估结果不一致者,分析原因。有再次手术指证者行二次手术并进行随访。有二次手术指证而患者不接受手术者仅进行跟踪随访。随访时间均为1年。结果手术指证确定方面:使用评分系统确定具备手术指证者44例,实际接受手术者48例。评分认为不应接受手术的4例均为Denis压缩骨折。在手术入路方面:确定具备前路手术指证者10例,后路指证者32例,前后联合手术者2例,无手术指证者4例;实际接受前路手术者4例,后路手术者44例,前后联合手术者0例。其中评分认为应接受前路手术或前后联合入路、实际却接受了后路手术的12例患者中,有8例实施了经后路伤椎植骨或经伤椎椎弓根固定(67%)。在固定节段方面:评分系统认为长节段固定者为18例,短节段固定者为26例,无手术指证者4例;实际接受长节段固定者17例,短节段固定者31例。结论对胸腰段骨折情况进行量化对确定手术指证、手术入路和手术固定节段等具有一定的指导意义。患者全身情况、手术医师的技术和手术医院的软硬件设施等因素对手术决策可能产生一定影响。Objective To evaluate a method which quantifies the operation decision-making of thoracolumbar fracture in clinical practice.Methods Firstly a thoracolumbar fracture operation decision-making system was constructed according to literature review and clinical experience.Then the assessment system was used to analyze the thoracolumbar fracture patients admitted from January 2010 to January 2011 in our department.According to the preoperative data,the decision-making system was used to evaluate the operation indications,operation approach and segments to be fixed.The results were compared with the actual condition of the patients.If the two results were not consistent,further analysis were required.If indication of second operation exists,another operation was suggested.If no operation indication exists,only follow-up was done.The follow-up time was one year.Results 44 cases should receive operation using the scoring system.And 48 cases receives operations actually.4 cases should not receive operation.10 cases should operation from anterior approach,32 posterior approach,2 cases combined approach.In fact,4 cases received operation from anterior approach,44 cases received operation from posterior approach,0 cases from combined approach.There were 12 cases who were thought to received anterior or combined approach operation received posterior approach operation,8 cases were operated with the anterior column bone graft from posterior approach or fractured vertebral pedicle fixation（67%）.18 cases with long segmental fixation and 26 cases with short-segment fixation using the scoring system.Actually 17 cases were fixed with long segments and 31 cases with short segments.Conclusion For the thoracolumbar fractures,quantification of the operation indications,operation approach and fixed segments help clinical practice.But general condition of patients,physicians technique and hospital facilities affect the operation decision-making.

关 键 词：胸腰段骨折 手术决策 量化 

分 类 号：R683.2[医药卫生—骨科学]