后路270°减压重建与前后路联合手术治疗胸腰椎三柱骨折伴不全瘫的对比研究  

Contrast study of 270° posterior decompression reconstruction and posterior combined with anterior approach operation in treatment of thoracolumbar three-column fracture with partial paraplegia

作　　者：李凤平 李宏杰 徐攀峰 

机构地区：[1]浙江省温岭市第一人民医院骨二科,浙江温岭317500 [2]浙江省温岭市第一人民医院骨一科,浙江温岭317500

出　　处：《中国医药导报》2014年第1期62-65,69,共5页China Medical Herald

基　　金：浙江省温岭市科技计划项目(编号2012WLCA0 069)

摘　　要：目的比较后路270°减压重建与前后路联合手术治疗胸腰椎三柱骨折伴不全瘫的临床效果。方法回顾分析2009年3月～2011年3月在温岭市第一人民医院骨科住院采用手术治疗的32例胸腰椎三柱骨折伴不全瘫患者资料。根据手术方式，将病例分为两组，A组14例，采用后路270。减压重建；B组18例，采用前后路联合手术治疗。临床评价措施包括术中失血量、手术时间、手术并发症、肺功能、Frankel分级、美国脊柱损伤学会（ASIA）运动神经评分等。影像学评估方法为在侧位X线片上测量Cobb角，以评价脊柱节段性后凸情况。结果①A组手术时间【（171．5±26．6）min】、术中失血量【（805．6±170．1）mL]显著低于B组[（225．3±22．8）min、（1126．0±175．5）mL]，差异均有统计学意义（均P〈0．01）。两组末次随访呼吸道感染以及肋间神经痛发生率等差异无统计学意义（P〉0．05）。B组术中血气胸、术后腹胀以及便秘发生率等显著高于A组，差异有统计学意义（P〈0．05）。A组术后肺活量[（2．7±014）L1大于B组[（2.3±0．5）L]，差异有统计学意义（P〈0．05）。②两组术前Cobb角比较[（26．4±4．2）°、（27．9±4．6）。]，差异无统计学意义（P〉0．05）；术后第2天及末次随访的Cobb角组间比较，差异均无统计学意义（P〉0．05）。两组术前及末次随访ASIA运动神经评分差异均无统计学意义（P〉0．05）。结论在椎管减压、脊柱稳定性重建以及矢状位对线维持方面，两种术式效果相当，但后路270°减压重建手术的创伤更小，手术时间更短，围术期并发症发生率更低。Objective To compare the effect of 270°posterior decompression reconstruction and posterior combined with anterior approach operation in treatment of thoracolumbar three-column fracture with partial paraplegia. Methods Total 32 patients of thoracolumbar three-column fracture with partial paraplegia from March 2009 to March 2011 in the First People＇s Hospital of Wenling City were selected and retrospectively analyzed. All the patients were divided into two groups according to the surgeries methods, 14 cases in group A were treated by 270° posterior decompression and reconstruction, 18 cases in group B were treated by posterior combined with anterior approach operation. Perioperative blood loss, operative time, operative complications, pulmonary function, Frankel scale and ASIA motor score were eval- uated; Cobb angle was examined in X ray film as imaging evaluation methods in order to evaluate the spinal segmental kyphosis situation. Results ①Operative time, perioperative blood loss in group A [（171.5±26.6） min, （805.6±170.1） mL] were all lower than those in group B [（225.3±22.8） min, （1126.0±175.5） mL], the differences were high statistically significant （all P 〈 0.01）. The differences of occurrence rate of respiratory tract infection and intercostal neuralgia be- tween the two groups during the last follow-up were not statistically significant （P 〉 0.05）. The occurrence rate of hemopneumothorax, abdominal distension, and constipation in group B were all higher than those in group A, the dif- ferences were statisticallv significant （P 〈 0.05）. Postonerative lung canacitv in groun A [（2.7±0.4） 13 was higher thanthat in group B [（2.3±0.5） L], the difference was statistically significant （P 〈 0.05）. ②The differences of Cobb angle between the two groups [（26.4±4.2）°, （27.9±4.6）°] before the operation was not statistically significant （P 〉 0.05）. The differences of Cobb angle between the two groups 2 days after the operation and last follo

关 键 词：270°减压 前后路联合入路 后路 胸腰椎爆裂骨折 三柱骨折 不全瘫 

分 类 号：R682.2[医药卫生—骨科学]