保留后柱稳定结构的后路减压术治疗胸腰椎爆裂骨折合并神经损伤的疗效  

Effects of retention of posterior column stabilizing structure decompression via posterior approach on spinal stability and neurological function in patients with thoracolumbar burst fracture

作　　者：高玉新 何啸波 GAO Yu-xin;HE Xiao-bo(Department of Orthopedics,Jiangdu Hospital of Traditional Chinese Medicine,Yangzhou 225200,China)

机构地区：[1]扬州市江都中医院骨科,江苏225200

出　　处：《中国临床神经外科杂志》2020年第3期158-160,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨保留后柱稳定结构的后路减压术治疗胸腰椎爆裂骨折合并神经损伤的效果。方法回顾性分析2017年1月至2019年3月后路减压术治疗的130例胸腰椎爆裂骨折合并神经损伤的临床资料。65例术中保留后柱稳定结构(观察组),65例术中不保留后柱稳定结构。结果观察组手术时间[(84.57±6.82)min]较对照组[(109.35±11.06)min]明显缩短(P<0.05),术中出血量[(162.04±27.14)ml]较对照组[(294.68±31.72)ml]明显减少(P<0.05)。两组术后1个月、术后1年锥体前高、锥体后高及Cobb角均较术前明显改善(P<0.05),而且观察组锥体前高和Cobb角明显优于对照组(P<0.05)。术后1年,观察组神经功能Frankel分级A、B、C、D、E级分别为2、6、15、19、23例;对照组Frankel分级A、B、C、D、E级分别为3、7、16、18、21例;两组术后Fran kel分级无明显差异(P>0.05)。观察组术后发生伤口感染和脑脊液漏各1例;对照组术后发生伤口感染2例,脑脊液漏1例。观察组术后并发症发生率(3.08%,2/65)与对照组(4.62%,3/65)无明显差异(P>0.05)。结论对于胸腰椎爆裂骨折合并神经损伤,后路减压术中保留后柱稳定结构,既可以进行有效减压,又有助于保持脊柱稳定性。Objective To investigate the effects of posterior decompression and posterior column stabilization on spinal stability,neurological function in the patients with thoracolumbar burst fracture complicated with nerve injury.Methods Of 130 patients with thoracolumbar burst fractures complicated with nerve injury treated in our hospital from January,2017 to March,2019,65(observed group)received posterior decompression and posterior column stabilization and 65(control group)received posterior decompression and posterior column decompression.The curative effects were analyzed.The neurological function was determined by Frankel grade 1 year after the surgery in all the patients.Results The operative duration and volumes of intraoperative blood loss and postoperative drainage were significantly fewer in the observed group than those in the control group(P<0.05).The heights of anterior and posterior edges of cone were significantly bigger and Cobb angle was significantly fewer in the observed group than those in the control group 1 year after the surgery(P<0.05).There was no significant difference in neurological function between both the groups 1 year after the surgery(P>0.05).The incidences of postoperative complications were 3.08%and 4.62%in the observed and the control groups respectively,and were insignificantly different from each other between both the group(P>0.05).Conclusions The retention of posterior column stabilization structure decompression via posterior approach is helpful to improving postoperative spinal stability and reducing neurological injury in the patients with thoracolumbar burst fractures and is worthy of clinical spread.

关 键 词：胸腰椎爆裂骨折 神经损伤 脊柱稳定性 神经功能 后路减压术 脊柱后柱稳定结构 

分 类 号：R683.2[医药卫生—骨科学] R651[医药卫生—外科学]