减压和非减压治疗无神经症状椎管内占位胸腰椎骨折的对比研究  

Comparative study of decompression and non-decompression surgeries in treatment of thoracolumbar fractures with intraspinal occupying and without neurological symptoms

作　　者：张大卫[1] 陈涛[1] 李国威[1] 张奎渤[1] 张荣凯[1] 黄宗文[1] 

机构地区：[1]中山大学附属第五医院脊柱外科,广东珠海519000

出　　处：《中国修复重建外科杂志》2017年第8期970-975,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的比较后路开窗减压与非减压手术治疗无神经症状椎管内占位胸腰椎骨折的疗效。方法回顾分析2008年10月—2015年10月收治的符合选择标准的97例椎管受压占椎管面积1/3~1/2的无神经症状胸腰椎骨折患者,其中采用后路开窗减压手术51例(减压组),采用后路非减压手术46例(非减压组)。两组患者性别、年龄、致伤原因、受伤节段、胸腰椎损伤分类及严重程度评分(TLICS)、合并伤、受伤至手术时间以及术前伤椎前缘相对高度、后凸Cobb角、椎管受压占椎管面积百分比、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、术后引流量、术后卧床时间、住院时间;术前、术后3 d及术后1年伤椎前缘相对高度、后凸Cobb角、椎管受压占椎管面积百分比及VAS评分、ODI、JOA评分。结果非减压组手术时间、术中出血量及术后引流量均明显少于减压组(P<0.05);两组术后卧床时间和住院时间比较差异无统计学意义(P>0.05)。减压组有4例发生术后脑脊液漏,经保守治疗后治愈;两组切口均Ⅰ期愈合,均未发生神经损伤、切口感染并发症。所有患者均获随访,随访时间10~18个月,平均11.7个月。两组椎体高度恢复满意,均无继发后凸畸形及继发神经症状加重。两组术后3 d及1年各影像学指标及疗效评分均较术前显著改善,差异有统计学意义(P<0.05);术后1年两组椎管受压占椎管面积百分比、VAS评分、ODI均显著低于术后3 d(P<0.05),JOA评分均显著高于术后3 d(P<0.05);术后1年伤椎前缘相对高度非减压组显著高于术后3 d(P<0.05),减压组与术后3 d比较差异无统计学意义(P>0.05)。除术后3 d非减压组椎管受压占椎管面积百分比及JOA评分高于减压组,VAS评分和ODI显著低于减压组,比较差异有统Objective To investigate the effectiveness of posterior non-decompression surgery in the treatment of thoracolumbar fractures without neurological symptoms by comparing with the conventional posterior decompression surgery. Methods Between October 2008 and October 2015, a total of 97 patients with thoracolumbar fractures with intraspinal occupying 1/3-1/2 and without neurological symptoms were divided into the decompression surgery group （51 cases） and the non-decompression surgery group （46 cases）. There was no significant difference in gender, age, cause of injury, injury segment, the thoracolumbar injury severity score （TLICS）, combined injury, disease duration, and preoperative relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, visual analogue scale （VAS）, Oswestry disability index （ODI）, and Japanese Orthopaedic Association （JOA） score between 2 groups （P〉0.05）. The operation time, intraoperative blood loss volume, postoperative drainage, bed rest time, hospitalization time, and relative anterior vertebral height, kyphosis Cobb angle, intraspinal occupying percentage, and VAS score, ODI, JOA score at preoperative and postoperative 3 days and 1 year were recorded and compared. Results The operation time, intraoperative blood loss volume, and postoperative drainage in non-decompression surgery group were significantly less than those in decompression surgery group （P〈0.05）. There was no significant difference in the postoperative bed rest time and hospitalization time between 2 groups （P〉0.05）. In decompression surgery group, 4 cases had cerebrospinal fluid leakage and healed after conservative treatment. All incisions healed by first intention, and no nerve injury or infection of incision occurred. All patients were followed up 10-18 months （mean, 11.7 months）. The recovery of vertebral body height was satisfactory in 2 groups, without secondary kyphosis and secondary nerve symptoms. The imaging indexes and effectiveness sco

关 键 词：胸腰椎骨折 神经症状 椎管内占位 后路减压 

分 类 号：R687.3[医药卫生—骨科学]