前路与后路手术治疗胸腰段椎体爆裂骨折的比较  

Anterior versus posterior procedures for thoracolumbar burst fracture

作　　者：舒莉[1] 吴萍 胡永胜[1] 田慧中[1] 郑君涛[1] 刘伟[1] SHU Li;WU Ping;HU Yong-sheng;TIANHui-zhong;ZHENG Jun-tao;LIU Wei(Orthopaedic Department, The Sixth Hospital Affiliated to Xinjiang Medical University, Wulumuqi 830002,China)

机构地区：[1]新疆医科大学第六附属医院骨科,乌鲁木齐830002

出　　处：《中国矫形外科杂志》2019年第10期901-906,共6页Orthopedic Journal of China

摘　　要：[目的]探讨胸腰段椎体爆裂骨折的手术方法选择。[方法]回顾性分析2013年5月～2016年1月手术治疗胸腰段椎体爆裂骨折78例,依据椎管内骨折块占位程度,32例采用前路手术,46例采用后路手术。记录两组手术切口长度、术中失血量、手术时间、术中术后并发症,采用ASIA脊髓损伤神经功能评级、JOA评分和ODI评分评价临床效果,并行影像学检查,比较两组Cobb角、椎管减压程度、植骨融合情况。[结果]两组均无死亡病例,前路组大出血2例、血气胸2例、脑脊液漏1例,后路组无严重并发症。前路组手术时间、术中出血量、切口长度、术后卧床时间均明显大于后路组,差异有统计学意义(P<0.05)。随访25～43个月,平均(29.56±10.35)个月,两组患者末次随访时ASIA评级均较术前有明显进步,两时间点间差异均有统计学意义(P<0.05);两组患者末次随访时JOA评分、ODI评分均较术前显著改善(P<0.05);两组患者末次随访时影像测量Cobb角、椎管内骨折块占位程度均较术前显著改善(P<0.05),前路组椎管内骨折块占位程度改善优于后路组(P<0.05)。[结论]前路和后路均为有效的手术入路选择,前路手术减压彻底,但手术创伤大,适合椎管内骨折块占位程度严重的患者;后路手术创伤小,适合椎管内骨折块占位程度轻及没有或脊髓神经损伤程度较轻的患者。[Objective] To investigate the selection of surgical procedures for thoracolumbar burst fracture.[Methods] A retrospective study was conducted on 78 patients who received surgical treatment for thoracolumbar burst fracture from May 2013 to January 2016 in our department. Based on the extent of canal involved, 32 patients underwent the anterior procedures, while 46 patients received the posterior operations. The incision length, intraoperative blood loss, operation time, complications were compared between the two groups. The American Spinal Injury Association (ASIA) grades was used for evaluation of the neurological function, whereas Japanese Orthopaedic Association (JOA) lumbar score and Oswestry disability index (ODI) were applied for assessment of the clinical consequences. In addition, the Cobb angle and extent of spinal canal involved were measured on images.[Results] No death happened in any patients of both groups during operation, although massive blood loss in 2, hemopneumothorax in 2 and cerebrospinal fluid leakage in 1 patient occurred in the anterior group, which did not lead serious consequences after proper treatment, while no aforesaid complications happened in any patient of the posterior group. The anterior group had significantly longer operation time, more intraoperative blood loss, larger incision and longer bed rest time than the posterior group (P<0.05). The follow-up period lasted for 25-43 months with an average of (29.56±10.35) months. In term of neurological function, the ASIA grades significantly improved at the latest follow up compared with those before operation in both group (P<0.05). The JOA score significantly increased, while the ODI score significantly decreased at the latest follow up in the two groups (P<0.05). Regarding to radiographic assessment, the Cobb angle and extent of spinal canal involved (the AB/CD value) significantly reduced at the latest follow up in both groups (P<0.06). By contrast, the anterior groups proved significantly superior to the posterior group in im

关 键 词：胸腰段椎体爆裂骨折 脊髓神经损伤 前路手术 后路手术 

分 类 号：R683.2[医药卫生—骨科学]