两种术式治疗胸腰椎骨折伴后侧韧带损伤的比较  

Comparison of two surgical techniques for thoracolumbar fracture accompanied with posterior ligamentous complex injury

作　　者：叶飞 周庆忠 郑礼鹏 冯大雄 YE Fei;ZHOU Qing-zhong;ZHENG Li-peng;FENG Da-xiong(Department of Spine Surgery,Affiliated Hospital,Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院脊柱外科,四川泸州646000

出　　处：《中国矫形外科杂志》2021年第16期1466-1470,共5页Orthopedic Journal of China

摘　　要：[目的]比较间接与直接减压内固定治疗Magerl B胸腰椎骨折伴后方韧带复合体(posterior ligamentous complex,PLC)损伤的临床效果。[方法]回顾性分析本院手术治疗的Magerl B型胸腰椎骨折伴PLC损伤的患者68例。依据医患沟通结果,36例采用间接减压术,32例采用直接减压术。比较两组围手术期、随访和影像资料。[结果]两组手术均顺利完成,术中无严重并发症。间接减压组手术时间、术中失血量、切口长度、术中透视次数、术后引流量和住院时间均显著优于直接减压组(P<0.05)。间接减压组恢复下地行走和完全负重活动时间均显著早于直接减压组(P<0.05)。随时间推移,两组患者ASIA神经功能评级、VAS和ODI评分均显著改善(P<0.05);术前两组间上述指标的差异无统计学意义(P<0.05),但是,术后3个月和末次随访时,间接减压组上述指标均显著优于直接减压组(P<0.05)。影像方面,与术前相比,末次随访时两组患者伤椎前缘高度比和伤椎后缘高度比均显著增加(P<0.05),局部后凸Cobb角均显著减少(P<0.05);末次随访时,间接减压组伤椎前缘高度比、伤椎后缘高度比和Cobb角均显著优于直接减压组(P<0.05)。[结论]对Magerl B型胸腰椎骨折伴PLC损伤,采用间接减压内固定和PLC修复的临床效果显著优于传统的直接减压内固定术。[Objective] To compare the clinical outcomes of indirect and direct decompression and internal fixation for Magerl type B thoracolumbar fractures accompanied with posterior ligamentous complex(PLC) injuries. [Methods] A retrospective study was conducted on 68 patients who received surgical treatments for Magerl type B thoracolumbar fractures accompanied with PLC injury in our hospital. According to the results of doctor-patient communication, 36 patients underwent posterior open-reduction and indirect-decompression(the PORID group), while the other 32 patients had posterior open-reduction and laminectomy performed(the PORL) group. The patients in the two groups were compared regarding to perioperative, follow-up and imaging documents. [Results] All the patients in both groups had operation performed successfully without serious complications during the operation. The PORID group was significantly superior to the PORL group in terms of operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy times, postoperative drainage and hospital stay(P<0.05). The PORID group resumed walking and full weight-bearing activities significantly earlier than the PORL group(P<0.05). The ASIA neurological function rating, VAS and ODI scores significantly improved over time in both groups(P<0.05). Although there were no significant differences in the above indicators between the two groups before surgery(P<0.05), the PORID proved significantly superior to the PORL group regarding to the ASIA neurological function rating, VAS and ODI scores at 3 months after operation and the latest follow-up(P<0.05).With respect of imaging evaluation, the ratios of the anterior and posterior vertebral heights significantly increased(P<0.05), while the kyphotic Cobb angle significantly reduced postoperatively compared with those before operation in both groups(P<0.05). At the latest follow-up, the PORID group was significantly better than the PORL group in the anterior and posterior vertebral height ratios and the Cobb angl

关 键 词：脊柱 Magerl B型胸腰椎骨折 后方韧带复合体 间接减压 直接减压 内固定 

分 类 号：R683.2[医药卫生—骨科学]