手术时机对胸腰椎骨折术后的影响  

Effect of surgical intervention timing on the treatment of thoracolumbar fractures

作　　者：史玉林[1] 王炳武[2] 伦登兴[2] 赵常海[1] 

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261041 [2]潍坊市人民医院脊柱外科,山东潍坊261041

出　　处：《中国骨与关节外科》2013年第4期345-348,共4页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:目前手术治疗胸腰椎骨折的方法较多,如后路、前路及前后路联合手术等。但对手术时机的选择仍存在较多的争议。目的:探讨胸腰椎骨折合并脊髓神经损伤的手术时机与术后改善率及手术并发症等的关系。方法:回顾性分析我院2009年3月至2012年1月手术治疗的84例胸腰椎骨折并脊髓神经损伤患者,其中男60例,女24例。年龄20～60岁,平均40.8岁。压缩骨折58例,爆裂骨折26例。对术后改善率、优良率、VAS评分、手术时间、出血量及手术相关并发症等因素进行分析。结果:所有患者平均随访19.4个月(11.5～36个月)。损伤后72h内手术32例(38.1%)分入A组;72h后手术52例(61.9%)分入B组。两组比较术后改善率、VAS评分无明显差异(P>0.05)。与72h后手术组比较,72h内手术组的优良率显著增高(P<0.05),但手术时间长、出血量多(P<0.01)。手术时机与并发症无显著相关性(P>0.05)。结论:对于脊髓神经损伤较重的胸腰椎骨折患者早期手术治疗可取得较理想的效果,但应充分考虑出血多、手术时间长及其他危险因素,权衡利弊个体化选择治疗方案。Background： There are many surgical treatments for thoracolumbar fracture, such as posterior approach, anterior approach and combied approach. But the choice of surgical intervention timing is still controversal. Objective： The goal of this study is to investigate the relationships between surgical intervention timing and post-operative recovery rate, and complications in patients with thoracolttmbar fractures combined with neurological deficit. Methods： Eighty-four patients with thoracolumbar fractures and neurological deficit underwent surgical treatment between March 2009 and January 2012 and were enrolled in this study. There were 60 males and 24 females with a mean age of 40.8 years （range, 20-60 years）. There were 58 patients with compression fractures and 26 patients with burst fractures. Postoper- ative recovery rate, VAS score, operation time, bleeding volume and operation-related complications were analyzed retro- spectively. Results： The average follow-up periods was 19.4 months （range, 11.5-36 months）. Thirty-two patients underwent surgery within 72 h after injury in group A. Fifty-two patients underwent surgery after 72 h of injury in group B. There were no sig- nificant differences in postoperative recovery rate and VAS score between two groups （/＇〉0.05）. Compared with group B, patients in group A achieved a higher excellent rate of treatment （P〈0.05）, while the operation time was much longer and- bleeding volume was much more （P〈0.01）. Surgical intervention timing was not related to operation-related complications （e〉0.05）. Conclusions： For spinal cord injury patients with thoracolumbar fractures, earlier surgical treatment can achieve better re- suits. However, there are some risk factors for early surgical treatment, such as bleeding, and longer operative time. There- fore, surgical intervention timing should be individual for thoracolumbar fracture.

关 键 词：胸腰椎骨折 手术治疗 预后 

分 类 号：R687.3[医药卫生—骨科学]