经椎弓根内侧入路减压复位固定术治疗胸腰段椎体爆裂骨折的效果及术后脊髓神经损伤转归的影响因素分析  

Effect of decompression,reduction and fixation through medial pedicle approach in treatment of thoracolumbar vertebral burst fracture and factors influencing outcome of postoperative spinal injury

作　　者：刘勇 葛世凯 姬超 LIU Yong;GE Shi-kai;JI Chao(General Hospital of Hebi Coal Group Co.,Ltd,Hebi,Henan 458000,China;Department of Emergency Medicine,Hebi Second People's Hospital,Hebi,Henan 458000,China)

机构地区：[1]鹤煤集团有限责任公司总医院骨科,河南鹤壁458000 [2]鹤壁市第二人民医院急诊科,河南鹤壁458000

出　　处：《医药论坛杂志》2024年第4期399-403,共5页Journal of Medical Forum

摘　　要：目的探究胸腰椎爆裂骨折采用经椎弓根内侧入路减压复位固定术疗效及术后脊髓损伤转归的高危因素。方法纳入在鹤煤集团有限责任公司总医院就诊的胸腰椎爆裂骨折患者102例,全部行经椎弓根内侧入路减压复位固定术,观察患者伤椎前缘高度丢失率、Cobb角、椎管侵占率及脊髓损伤转归情况,并对术后脊髓损伤转归的高危因素进行分析。结果术后1年患者伤椎前缘高度丢失率、Cobb角、椎管侵占率均低于术前(P<0.05);术后患者脊髓损伤分级情况优于术前(P<0.05);单因素分析显示,术前损伤情况、激素在伤后8 h内应用、椎管侵占率均与术后脊髓损伤转归有关(P<0.05);术前损伤情况、激素在伤后8 h内应用、椎管侵占率为术后脊髓损伤转归的高危因素(P<0.05)。结论胸腰段椎体爆裂骨折采用经椎弓根内侧入路减压复位固定术疗效确切,可有效恢复伤椎高度,改善脊髓神经功能,椎管侵占率、术前损伤程度、激素在伤后8 h内应用为影响患者术后脊髓神经损伤转归的主要因素。Objective To explore the curative effect of decompression,reduction and fixation through medial pedicle ap-proach on thoracolumbar vertebral burst fracture,and factors influencing the outcome of postoperative spinal injury.Methods This study included 102 patients with thoracolumbar vertebral burst fracture treated with decompression,re-duction and fixation through medial pedicle approach in our Hospital.The anterior vertebral height loss rate,Cobb an-gle,spinal canal invasion rate and the outcome of spinal injury were observed.The high-risk factors for the outcome of postoperative spinal injury were analyzed.Results The anterior vertebral height loss rate,Cobb angle and spinal canal invasion rate at 1 year after operation were lower/smaller than those before operation(P<0.05).The grade of spinal injury after operation was better than that before operation(P<0.05).Univariate analysis showed that preoperative in-jury,hormone use within 8h after injury and spinal canal invasion rate were related to postoperative spinal injury(P<0.05).Preoperative injury,hormone use within 8h after injury and spinal canal invasion rate were high-risk fac-tors for the outcome of postoperative spinal injury(P<0.05).Conclusion Decompression,reduction and fixation through medial pedicle approach is effective in the treatment of thoracolumbar vertebral burst fracture,which can effec tively restore the height of the injured vertebra,and improve spinal nerve function.Spinal canal invasion rate,preopera-tive injury degree,and hormone use within 8h after injury are main factors influencing the outcome of postoperative spi-nal nerve injury.

关 键 词：胸腰椎爆裂性骨折 椎弓根减压 内固定 脊髓损伤 影响因素 

分 类 号：R683.2[医药卫生—骨科学]