前后路减压治疗胸腰段脊柱骨折合并脊髓损伤疗效观察  

Observation on the Efficacy of Anterior and Posterior Decompression in the Treatment of Thoracolumbar Spine Fracture Complicated with Spinal Cord Injury

作　　者：刘杰[1] 刘军[1] 董晖 张陆 Liu Jie;Liu Jun;Dong Hui;Zhang Lu(Department 2 of Orthopedics,People’s Hospital of Henan University of Chinese Medicine(People’s Hospital of Zhengzhou),Zhengzhou,Henan 450000,China)

机构地区：[1]河南中医药大学人民医院(郑州人民医院)骨二科,河南郑州450000

出　　处：《中国烧伤创疡杂志》2021年第6期417-420,共4页The Chinese Journal of Burns Wounds & Surface Ulcers

摘　　要：目的研究探讨前、后路减压术治疗胸腰段脊柱骨折合并脊髓损伤的临床效果。方法选取2017年3月至2019年12月河南中医药大学人民医院收治的70例胸腰段脊柱骨折合并脊髓损伤患者作为研究对象,并按照随机数表法将其随机分为前路组(35例)和后路组(35例),其中前路组患者采用经胸腹膜外入路的前路减压手术治疗,后路组患者采用经胸背部入路的后路减压手术治疗,对比两组患者术中出血量、手术时间、Cobb角、伤椎前缘高度、神经功能评分及患者满意度。结果前路组患者术中出血量明显多于后路组、手术时间明显长于后路组(t=218.643、65.366,P均<0.001);术后5周,前路组患者Cobb角明显大于后路组、伤椎前缘高度及触觉与运动功能评分均明显高于后路组(t=9.224、6.817、3.273、2.676,P<0.001、P<0.001、P=0.002、P=0.009);术后3个月随访,前路组患者满意18例、较为满意15例、不满意2例,明显优于后路组患者的满意12例、较为满意13例、不满意10例(Z=-2.125,P=0.034)。结论前路减压术治疗胸腰段脊柱骨折合并脊髓损伤能够更好地重建椎体高度,矫正脊柱畸形,神经恢复效果更好,患者满意度更高。Objective To study the clinical efficacy of anterior and posterior decompression in the treatment of thoracolumbar spine fracture complicated with spinal cord injury.Methods 70 patients with thoracolumbar spine fractures and spinal cord injuries,admitted to People’s Hospital of Henan University of Chinese Medicine from March 2017 to December 2019,were enrolled and divided,using random number table,into anterior group(n=35)treated with anterior decompression surgery through the transpleural retroperitoneal approach and posterior group(n=35)treated with posterior decompression surgery through the transthoracic and back approach.Intraoperative blood loss,surgery time,Cobb angle,height of the anterior edge of the injured vertebrae,neurological function score and patients’satisfaction were compared between the two groups.Results The intraoperative blood loss in anterior group was significantly more than posterior group,and the surgery time was significantly longer(t=218.643 and 65.366,both P<0.001).5 weeks after surgery,the Cobb angle was significantly larger,and the height of the anterior edge of the injured vertebrae and the neurological severity score were all markedly higher in anterior group as compared with posterior group(t=9.224,6.817,3.273,2.676,P<0.001,P<0.001,P=0.002,P=0.009).At 3-month follow-up,18 patients were satisfied with the treatment,15 patients were relatively satisfied,and 2 patients were dissatisfied in anterior group,which was significantly better than posterior group in which 12 patients were satisfied,13 patients were relatively satisfied and 10 patients were dissatisfied(Z=-2.125,P=0.034).Conclusion Anterior decompression surgery in the treatment of thoracolumbar spine fracture combined with spinal cord injury can better rebuild vertebral body to its original height,correct spinal deformities,restore nerve function,and realize high patients’satisfaction,presenting high value of clinical application.

关 键 词：前路减压 后路减压 胸腰段脊柱骨折 脊髓损伤 神经功能 

分 类 号：R687.3[医药卫生—骨科学] R651.2[医药卫生—外科学]