开窗减压撬拨复位联合椎体内植骨治疗伴椎管侵占胸腰椎骨折的效果  

Effect of laminectomy decompression and poking reduction combined with vertebral bone graft in the treatment of thoracolumbar fracture with spinal canal encroachment

作　　者：尚平福 徐钦华[1] 王贵方[1] 李东风[2] 

机构地区：[1]邯郸钢铁集团有限责任公司职工医院骨二科,河北邯郸056001 [2]邯郸市中心医院骨二科,河北邯郸056001

出　　处：《中国医药导报》2017年第21期109-112,132,共5页China Medical Herald

基　　金：河北省邯郸市科学技术研究与发展计划项目(1123108080-2)

摘　　要：目的探讨椎板开窗减压联合经伤椎椎弓根撬拨复位椎体内植骨治疗胸腰椎骨折的临床效果。方法回顾性分析2010年8月~2013年5月在邯郸钢铁集团有限责任公司职工医院收治的63例损伤类型为AO-A型且伴有椎管侵占的胸腰椎骨折患者资料,根据手术方式将其分为两组,A组:30例,采用椎板开窗脊髓减压撬拨复位椎体内植骨术;B组:33例,采用开窗减压短节段椎弓根钉撑开固定术。分别记录两组患者手术时间、术中出血量和术前、术后及末次随访时的椎体相对高度、局部后凸角(Cobb角)及Oswestry功能障碍指数(ODI)。结果所有手术均顺利完成,切口均Ⅰ期愈合。B组手术时间及术中出血量上明显少于A组,差异有统计学意义(P<0.05)。术后1周,两组患者伤椎高度和后凸畸形均有明显改善(P<0.05);且A组椎体高度恢复明显优于B组(P<0.05);末次随访与术后1周比较,B组椎体高度降低,局部Cobb角增大(P<0.05),A组患者则维持较好(P>0.05)。两组患者术后ODI评分均显著降低(P<0.05),两组不同时间点比较,差异均无统计学意义(P>0.05)。结论开窗减压撬拨复位联合椎体内植骨术虽然会增加手术时间,但可更好地维持伤椎高度及脊柱序列,同时减少空壳样椎体的发生。Objective To investigate the clinical effect of laminectomy decompression and poking reduction combined with vertebral bone graft for thoracolumbar fracture with spinal canal encroachment. Methods All of 63 patients who had thoracolumbar fracture in AO-A type accepted operation in the period of August 2010 to May 2013. They were divided into two groups based on the surgical procedure. The group A（30 cases） was accepted laminectomy decompression and poking reduction combined with vertebral bone graft. The group B（33 cases） was accepted short-segment fixation and laminectomy decompression. The operative time, intraoperative blood loss, vertebral body height, Cobb angle, and Oswestry disability index（ODI） before and one week after operation, and final follow-up were recorded and analyzed.Results All the operations were completed successfully, and all incisions were healed in phase Ⅰ. The operation time and intraoperative blood loss in the group B were less than those in the group A（P〈0.05）. One week after operation,the vertebral body height, local Cobb angle of the two groups were better than those before operation, and the vertebral body height, local Cobb angle in the group A were better than those in the group B（P〈0.05）. At final follow-up time,in the group B, the vertebral body height was lost, and local Cobb angle was increased（P〈0.05）, while group A was sustained well（P〉0.05）. Conclusion Laminectomy decompression and poking reduction combined with vertebral bone graft will, but can maintain the height of the vertebral body well and avoid the shell-like vertebral body occurred, although it will increase the operation time.

关 键 词：胸腰椎骨折 撬拨复位 椎体内植骨 椎板减压 

分 类 号：R683[医药卫生—骨科学]