摘要
目的比较间接减压和开放减压在治疗无神经症状型胸腰椎爆裂型骨折的疗效。方法2004年4月-2008年6月采用后路椎弓根钉内固定器AtlasFixator(AF)系统治疗52例无神经症状型胸腰椎爆裂型骨折患者。其中男34例,女18例;年龄31～63岁,平均43.1岁。损伤部位:T115例,T1224例,L116例,L27例。受伤至手术时间3～8d,平均4.4d。根据减压方式不同分为间接减压组(A组)和开放减压组(B组),每组各26例。两组患者性别、年龄、损伤部位、受伤至手术时间比较差异无统计学意义(P>0.05),有可比性。记录手术时间、失血量,于术前、术后即刻、末次随访时摄X线片测量伤椎前缘相对高度和Cobb角,CT检测椎管占位率,并行统计学分析。结果A、B组手术时间分别为(87.3±7.9)、(125.3±13.6)min,失血量分别为(273.7±23.4)、(512.6±37.7)mL,两组比较差异均有统计学意义(P<0.05)。两组均获随访,随访时间A组11～31个月,平均17.4个月;B组12～33个月,平均19.9个月。患者术后切口均Ⅰ期愈合,无死亡和脊髓损伤者。B组术后18个月出现椎弓根钉松动3例,术后22个月椎弓根钉断裂1例;术后12个月顽固性胸腰背疼痛3例,经对症治疗其中2例明显好转,1例持续顽固性疼痛。影像学检测示术前、术后即刻和末次随访时两组间伤椎前缘相对高度、Cobb角、椎管占位率比较差异均无统计学意义(P>0.05);两组组内各时间点比较差异均有统计学意义(P<0.05),术后均较术前有明显改善。两组间伤椎前缘相对高度、Cobb角、椎管占位率的脊柱矫正度(术后即刻与术前的差值)比较差异均无统计学意义(P>0.05);A组伤椎前缘相对高度和Cobb角的随访丢失率(末次随访时与术后即刻的差值)均低于B组,比较差异有统计学意义(P<0.05)。结论两种减压方式的近期脊柱矫正及减压效果均满意,但间接减压具有手术时间短、失血量少、脊柱矫正度及随访丢失率低、脊柱稳定性好的优点,建议治疗无神经症状型胸腰椎爆裂型骨折时在严格掌握适应证前提下首选间接减压方式。
Objective To compare the clinical effects of indirect decompression versus open decompression to vertebral canal in treatment of thoracolumbar burst fractures without neurologic deficit.Methods From April 2004 to June 2008,52 cases of thoracolumbar burst fracture without neurologic deficit underwent posterior exposition,reduction and fixation with Atlas Fixator（AF）instrumentation.There were 34 males and 18 females with an average age of 43.1 years（range, 31-63 years）.The affectd locations were T11 in 5 cases,T12 in 24 cases,L1 in 16 cases,and L2 in 7 cases.The time from injury to operation was 3-8 days（4.4 days on average）.All cases were devided into indirect decompression group（group A）and open decompression group（group B）.There were no statistically significant differences（P0.05）in sex,age,affect site,and disease course between two groups.The operative time,blood loss were recoded.Preoperatively,immediately postoperstively and at last follow-up,the height of the fracture vertebra and the Cobb angle were obtained from X-ray pictures and were statistically analysed.Radiographic parameters on computed tomography（CT）pictures were used to get the encroachment rate of vertebral canal.Results The operative time was（87.3±7.9）minutes and（125.3±13.6）minutes,and the blood loss was（273.7± 23.4）mL and（512.6±37.7）mL in groups A and B,respectively;showing statistically significant differences（P0.05）.The average follow-up time was 17.4 months（range,11-31 months）in group A and 19.9 months（range,12-33 months）in group B. All wounds achieved primary healing postoperatively without deaths and spinal cord injuries.Postoperative complications in group B included 3 cases of screws loosening,1 case of screw breakage,and 3 cases of low back pain,and were given symptomatic management.There were no statistically significant differences（P0.05）in the height of the fracture vertebra,the Cobb angle and the encroachment rate of vertebral canal preoperatively or postoperstively between two groups.There were statistically significant differences（P0.05）in the above three parameters between preoperation and postoperation in two groups,but there were no statistically significant differences（P0.05）in the spinal correction between two groups.The losing-rate of spinal correction of the height of the fracture vertebra and the Cobb angle of group A was lower than group B,showing statistically significant differences（P0.05）.Conclusion The short-term results of two decompression styles in treatment of thoracolumbar burst fractures without neurologic deficit were satisfactory,but indirect decompression has more merits than open decompression： shorter operative time,less blood loss,lower losing-rate of spinal correction,and better stabilization of vertebral column.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期32-36,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胸腰椎爆裂型骨折
内固定
间接减压
开放减压
比较研究
Thoracolumbar burst fractures Internal fixation Indirect decompression Open decompression Comparison study
