前、后路不同手术方式治疗严重腰椎不稳定型骨折临床疗效分析  

Clinical effect of anterior and posterior surgical treatments for lumbar vertebrae burst fractures

作　　者：唐炜东[1] 

机构地区：[1]青海省人民医院骨科,青海西宁810007

出　　处：《中国现代医学杂志》2015年第6期56-60,共5页China Journal of Modern Medicine

摘　　要：目的评价前、后路手术治疗腰椎爆裂性骨折的效果及特点。方法回顾性分析2007年8月~2011年8月手术治疗的79例腰椎爆裂性骨折。根据患者伤情选择不同手术方式,后路57例、前路12例、前后联合入路10例。观察手术时间、出血量、前后神经功能恢复情况（采用ASIA标准评定）、手术前后伤椎Cobb角以及矫正度丢失、骨性融合率、内固定失效率等。结果 79例患者均获随访,平均随访时间（28.3±5.5）个月（19~68个月）,除5例完全性截瘫患者神经功能无变化外,63例不全瘫患者术后神经功能ASIA分级均恢复1级或1级以上。后路手术在手术时间、出血量方面较前路或前后联合手术明显较少（P〈0.05）。三种手术方法术后伤椎Cobb角以及神经功能的恢复均较术前明显改善（P〈0.05）;后路手术术后矫正度丢失明显高于前路或前后联合入路（P〈0.05）;后路手术中有5例患者发生内固定断裂,而前后联合入路无1例发生内固定断裂;三种方法在骨性融合率和术后神经功能恢复方面差异无统计学意义（P〉0.05）。结论三种手术方法均能有效治疗腰椎爆裂性骨折,临床疗效满意;后路手术创伤小手术简单,但易出现内固定断裂和术后矫正度丢失;前路和前后联合手术创伤大,但术后矫正度丢失较少;因此,术者应个体化选择手术方法,以期获得最佳的治疗效果。【Objective】To evaluate the results and characteristics of surgical treatments through anterior and posterior approach for lumbar vertebrae burst fractures.【Methods】From March 2005 to March 2008, 79 patients with lumbar vertebrae burst fractures were treated by operation. Different approaches were selected according to conditions of injury： posterior approach（57 patients）, anterior approach（12 patients）, and anterior combined with posterior approach（10 patients）. Their data were observed and assessed, including operative time, blood loss, improved nerve function, changes of Cobb angle, correction loss of Cobb angle, bone fusion rate, and internal fixation failure rate.【Results】All the 79 patients were followed up for 19~68 months [a mean of（28.3±5.5） months]. Except for no changes in the 5 complete paralysis cases, the A SIA classification of postoperative nerve function in the 63 incomplete paralysis cases was improved by 1 grade or more. The posterior approach had a shorter operative time and less blood loss than the anterior approach and the anterior combined with posterior approach（P〈0.05）. The ASIA grade and the Cobb angle were significantly improved after each of the three operations compared to preoperation ones（P〈0.05）. The Cobb angle correction loss in the patients with posterior approach was significantly larger than in those with anterior approach and the anterior combined with posterior approach（P〈0.05）. 5 cases with posterior approach were found with screw breakage, and those with anterior combined with posterior approach were not found with screw breakage. There were no significant differences in the rate of bone fusion and postoperative improved nerve function between the three approaches（P〉0.05）.【Conclusions】The three surgical approaches can effectively treat lumbar vertebrae burst fractures, and achieve satisfactory clinical outcomes. However, the anterior, posterior approaches, and the anterior combined with posterior approach, have their

关 键 词：前路 后路 前后联合 腰椎 爆裂性骨折 

分 类 号：R687.3[医药卫生—骨科学]