伤椎后1/3切除重建治疗胸腰椎爆裂性骨折的疗效及对脊髓神经功能的影响  

Clinical efficacy of posterior 1/3 of injured vertebrae corpectomy reconstruction in treatment of thoracolumbar burst fractures and its influence on spinal nerve function

作　　者：李峰[1] 庞争取[1] 范达文[1] 张修春 LI Feng;PANG Zhengqu;FAN Dawen(Department of Orthopedics,the First People＇s Hospital of Aksu,Xinjiang,Akesu 843000,China)

机构地区：[1]新疆阿克苏地区第一人民医院骨科,843000

出　　处：《临床外科杂志》2018年第9期705-708,共4页Journal of Clinical Surgery

摘　　要：目的探讨伤椎后1/3切除重建治疗胸腰椎爆裂性骨折的疗效及对脊髓神经功能的影响。方法胸腰椎爆裂性骨折病人82例,随机分为观察组和对照组,每组各41例。观察组行伤椎后1/3切除重建减压内固定治疗,对照组行前路椎体次全切除重建减压内固定治疗。比较两组手术情况及手术前后影像学表现、ASIA脊髓神经功能分级、疼痛视觉模拟评分量表(VAS)评分及日本骨科协会(JOA)腰椎功能评分。结果观察组的手术时间、术中出血量及术后引流量均低于对照组,植骨融合率高于对照组(P <0. 05);术后末次随访时,观察组的JOA评分及ASIA脊髓神经功能分级优于对照组,VAS评分、伤椎前缘高度及Cobb角丢失度低于对照组(P <0. 05);观察组的并发症发生率为2. 44%,与对照组的4. 88%比较差异无统计学意义(P> 0. 05)。结论伤椎后1/3切除重建治疗胸腰椎爆裂性骨折能够改善病人的脊髓神经功能,减少椎体矫正度丢失,改善功能康复质量。Objective To investigate the clinical efficacy of posterior 1/3 injured vertebrae corpectomy reconstruction in treatment of thoracolumbar burst fractures and its influence on spinal nerve function. Methods 82 patients with thoracolumbar burst fractures were randomly divided into observation group and control group,with 41 cases in each group. The observation group underwent posterior 1/3 corpectomy reconstruction,decompression and internal fixation,the control group underwent anterior subtotal corpectomy reconstruction,decompression and internal fixation. The surgical conditions,imaging findings,ASIA spinal cord function grading,pain Visual Analogue Scale（ VAS） scores and Japanese Orthopaedic Association（ JOA） scores before and after surgery between the two groups were compared. Results The operative time,intraoperative blood loss and postoperative drainage in the observation group were lower than these in the control group,while the bone graft fusion rate was significantly higher than that in the control group（ P〈0. 05）; At final flow-up,the JOA score and ASIA grading in the observation group was significantly higher than the control group,while the VAS score,the veaebral height loss and Cobb angle loss were significantly lower than the control group（ P〈0. 05）. The incidence of complications in the observation group was 2. 44%,showed no significant difference with 4. 88% in the control group（ P〈0. 05）. Conclusion Posterior 1/3 corpectomy reconstruction for thoracolumbar burst fractures can improve the spinal cord nerve function and reduce vertebral correction loss,improve the quality of functional rehabilitation.

关 键 词：胸腰椎爆裂性骨折 前路手术 伤椎后1/3切除 脊髓神经功能 

分 类 号：R687.3[医药卫生—骨科学]