后路椎管减压植骨内固定治疗胸腰椎骨折合并脊髓损伤  

Posterior spinal canal decompression combined with instrumented fusion for thoracolumbar fracture accompanied with spinal cord injury

作　　者：王雪松[1] 张烽[2] 徐瑞生[1] 吴洁石[1] 薛骏[1] 韩冬[3] WANG Xue-song;ZHANG Feng;XU Rui-sheng;WU Jie-shi;XUE Jun;HAN Dong(Department of Orthopedics,The Third People's Hospital of Wuxi,Jiangnan University,Wuxi214000,China;Department of Orthopedics,Affiliated Hospital,Nantong University,Nantong 226001,China;Department of Intensive Care Medicine,The Third People's Hospital of Wuxi,Jiangnan University,Wuxi214000,China)

机构地区：[1]无锡市第三人民医院(江南大学附属医院)骨科,江苏无锡214041 [2]南通大学附属医院骨科,江苏南通226001 [3]无锡市第三人民医院(江南大学附属医院)重症医学科,江苏无锡214041

出　　处：《中国矫形外科杂志》2019年第14期1249-1253,共5页Orthopedic Journal of China

基　　金：国家自然科学基金项目(编号:81501610);无锡市卫生计生科研面上项目(编号:MS201717);江南大学大学生创新训练项目(编号:2018547Y);江南大学公共卫生研究面上项目(编号:JUPH201808)

摘　　要：[目的]探讨后路椎管减压植骨内固定治疗胸腰椎骨折合并脊髓损伤的临床疗效。[方法]对2013年1月~2017年3月收治的100例胸腰椎骨折合并脊髓损伤患者进行回顾性分析,所有患者均行后路椎管减压植骨内固定治疗。采用ASIA评级,以及VAS评分、SF-36量表和ODI评分评价临床效果;行影像检查,测量后凸Cobb角、椎管侵占率和椎体前缘压缩率等。[结果]100患者手术均成功完成,1例脑脊液漏,2例切口延迟愈合,1例切口感染,经相应处理,无不良后果。所有患者获得15~45个月随访。患者ASIA神经功能分级由术前B级31例,C级41例,D级28例,显著改进为末次随访时C级5例,D级56例,E级39例,差异具有统计学意义(P<0.05)。随时间推移,VAS和ODI评分显著减少,而SF-36量表评分显著增加,不同时间点间的差异均有统计学意义(P<0.05)。与术前相比,患者术后VAS评分、SF-36量表、ODI评分显著改善。与术前比较,术后后凸Cobb角、椎管侵占率等指标显著降低(P<0.05),而术后各不同时间点间比较各指标差异无统计学意义(P>0.05)。[结论]后路椎管减压植骨内固定术治疗胸腰椎骨折合并脊髓损伤临床疗效可靠。[Objective]To investigate the clinical outcomes of posterior spinal canal decompression combined with instrumented fusion for thoracolumbar fracture accompanied with spinal cord injury.[Methods]A retrospective study was conducted on a total of 100 patients who underwent posterior spinal canal decompression combined with instrumented fusion for thoracolumbar fracture accompanied with spinal cord injury from January 2013 to March 2017 in our department.The American Spinal Injury Association(ASIA)grading for neurological function,visual analogue scale(VAS)for pain,36-Item Short Form Survey(SF-36)and Oswestry Disability Index(ODI)were used for assessment of the clinical consequences,and the Cobb angle,ratios of anterior vertebral compression and canal occupied were measured on radiographs.[Results]All the patients received successful surgical procedures,nevertheless 1 of them suffered from cerebrospinal fluid leakage,2 had delay incision healing and 1 got incision infection,without serious consequences after proper corresponding handling.The follow-up period lasted for 15~45months with an average of(36.72±12.45)months.The neurological function in term of ASIA grading significantly improved from Grade B in 31,Grade C in 41 and Grade D in28 patients preoperatively to Grade C in 5,Grade D in 56 and Grade E in 39 patients at the latest follow up,which proved statistically significant(P<0.05).As time went,both the VAS and ODI scores significantly decreased,while the SF-36 score significantly increased(P<0.05),with statistically significant differences compared the scores before operation with those postoperatively.In term of radiographic assessment,the Cobb angle,ratio of anterior vertebral compression and ratio of canal occupied significantly decreased postoperatively compared with those preoperatively(P<0.05),whereas no statistically significant changes in aforesaid radiographic parameters were noticed among the time points postoperatively(P>0.05).[Conclusion]This posterior spinal canal decompression combined with inst

关 键 词：胸腰椎骨折 脊髓损伤 后路椎管减压 固定融合术 

分 类 号：R683.2[医药卫生—骨科学]