摘要
目的比较分析胸腰椎骨折在后路器械固定下对椎管间接减压与开放减压两种方式的临床疗效。方法回顾性分析2001年1月～2004年12月收治的76例胸腰椎骨折患者,将其分为两组：42例行后路暴露、椎弓根螺钉系统复位内固定术,将其定义为间接减压组；34例行半椎板或全椎板减压,椎弓根螺钉内固定,半椎板、横突或关节突融合术,定义为开放减压组。观察两组的术中情况及并发症,评价各组的脊柱矫形、椎管占位、复位及神经功能恢复情况,各组观察指标进行统计学比较分析。结果间接减压组的平均手术时间、术中出血量及术后引流量分别为65 min、150 mL和70 mL,而开放减压组为110min、360 mL和145 mL,两组间差异有显著性意义(P＜0．05)。椎体前高、后高、Cobb角随访时的丢失率及丢失角度两组分别为：间接减压组为2．3%、1．2%和0．5°,开放减压组为7．7%、2．6%和3．1°,两组间差异无显著性意义(P＞0．05)。间接减压组术后椎管平均减压30．2%,开放减压组32．2%。两组术后Frankel分级均有1～2级改善。结论间接减压组较开放减压组具有手术时间短、术中出血少、术后引流量少、脊柱矫正度丢失率低、术后康复快、脊柱稳定性好及无明显并发症的优点,两组在椎管减压程度及神经功能恢复进步方面效果相近。
Objective To evaluate the clinical effects of indirect decompression and open decompression to vertebral canal in treatment of thoracolumbar fractures with posterior pedicle instrument fixation. Methods Seventy-six cases of thoracolumbar fracture who were treated in our hospital from January 2001 to December 2004. They were two groups： in the indirect decompression group, 42 cases underwent posterior exposition, reduction and fixation with pedicle screws; in the open decompression group, 34 cases were treated with posterior hemi-laminectomy or full-laminectomy, internal fixation with pedicle screws and fusion of hemi-lamina or transverse process or articular process. The perioperative dataand complications in the two groups were analyzed. The reshaping of vertebral column, volume of vertebral canal, and Frankel grading were evaluated. The data were compared statistically. Resuits The mean operation time, perioperative bleeding, postoperative drainage were 65 min, 150 mL, and 70 mL respectively in the indirect decompression group, and 110 min, 360 mL, and 145 mL in the open compression group. In the former group, the losing rates of anterior and posterior heights of vertebra body, and lost Cobb angles at the last follow-up were 2. 3%, 1.2 %, and 0.5 respectively; while in the latter group, those were 7.7%, 2. 6%, and 3.1° respectively. The vertebra canal was averagely decompressed 30. 2% in the indirect decompression group and 32.2% in the open one. Frankel grading was improved by one or two grades after the operation in both groups. Conclusions On one hand indirect decompression can lead to decompression and functional recovery as well as the open one, but on the other hand it has more merits than the open one： shorter operation time, less perioperative bleeding, less postoperative drainage, lower losing-rate of spinal correction, quicker recovery, good stabilization of spinal column and no obvious complications.
出处
《中华创伤骨科杂志》
CAS
CSCD
2006年第6期536-539,共4页
Chinese Journal of Orthopaedic Trauma
关键词
胸椎
腰椎
骨折
减压
Thoracic vertebra
Lumbar vertebra
Fracture
Indirect decompression
