摘要
目的 评价后路减压短节段椎弓根内固定治疗不同时段胸腰椎骨折伴神经功能不全损伤的临床疗效.方法 将79例行后路减压短节段椎弓根内固定治疗的胸腰椎骨折伴神经功能不全损伤患者按受伤与手术时间间隔不同分为≤24h组（41例）和＞24h组（38例）,通过影像学及神经功能恢复情况来评估疗效.结果 术后住院期间均行X线复查,术后10～14 d出院,切口均一期愈合.79例均获得随访,平均23.5（15 ～32）个月.术中未出现手术源性神经损伤及术后感染,术后无脊髓损伤加重现象,未发生内置物断裂、折弯和螺钉松动现象.两组术后3d和末次随访伤椎压缩率、后凸Cobb角均较术前明显改善[≤24 h组：（7.9±4.2）％、（8.5±5.0）％比（40.8±8.4）％和（3.9±2.5）°、（4.2±2.6）°比（28.1±13.1）°;＞24h组：（8.8±4.8）％、（9.2±4.8）％比（41.7±7.6）％和（5.3±2.6）°、（5.7±2.7）°比（27.6±12.1）°],差异有统计学意义（P＜0.05）,但两组间比较差异无统计学意义（P＞0.05）.两组术后3d椎管狭窄率均较术前明显改善[≤24h组：（5.3±1.5）％比（41.4±6.1）％;＞24h组：（6.8±1.1）％比（40.5±5.4）％],差异有统计学意义（P＜0.05）,且≤24h组明显优于＞24 h组,差异有统计学意义（P＜0.05）.两组末次随访时,脊髓功能大部分有ASIA分级1～2级的恢复,≤24 h组平均改善1.4级,＞24 h组平均改善1.2级.结论 及时行后路减压短节段椎弓根内固定治疗胸腰椎骨折伴神经功能不全损伤能很好地重建脊柱的稳定性,有利于神经功能的恢复.
Objective To evaluate the chnical effect of posterior decompression and shortsegment pedicle instrumentation treating for thoracolumbar fracture with neurologic deficits in different time intervals.Methods Seventy-nine cases of thoracolumbar fracture with neurologic deficits were treated with shortsegment pedicle instrumentation combined with decompression according to the injury and surgery patients with injury of different time interval were divided into ≤24 h group （41 cases） and 〉 24 h group （38 cases）,the curative effect was evaluated by imaging and nerve function recovery.Results Postoperative hospital stay were performed X-ray check,10-14 d after hospital discharge,were primary healing of incision.A total of 79 patients with thoracolumbar fracture combined with neurologic deficits were followed up for 23.5 （15-32） months averagely.Did not appear in the source sex procedure for postoperative infection,nerve injury and postoperative spinal cord injury aggravated phenomenon,not implants rupture,bending and screw loose phenomenon.There was significant difference at 3 d postoperative and the last follow-up in the rate of vertebral compression,cobb＇ s angle and spinal canal stenosis rate in two groups [≤ 24 h group：（7.9 ± 4.2）%,（8.5 ± 5.0）% vs.（40.8 ± 8.4）% and （3.9 ± 2.5）°,（4.2 ± 2.6）° vs.（28.1 ± 13.1）° ; 〉 24 h group：（8.8 ± 4.8）%,（9.2 ± 4.8）% vs.（41.7 ± 7.6）% and （5.3 ± 2.6）°,（5.7 ± 2.7）° vs.（27.6 ± 12.1）°] （P 〈 0.05）,but there was no statistically significant difference between two groups （P 〉 0.05）.The stenosis rate in two groups at 3 d postoperative was obviously better than preoperative[≤24 h group：（5.3 ± 1.5）% vs.（41.4 ± 6.1）%; 〉 24 h group：（6.8 ± 1.1）% vs.（40.5 ± 5.4）%] （P 〈 0.05）,and ≤ 24 h group was superior to 〉 24 h group,there was significant difference （P 〈 0.05）.At the last follow-up,the neurological function with ASIA grade 1-2 level recovery,≤24 h group mean improved 1.4 level,and 〉 24 h group mean improved 1.2 level.Conclusion The opertion of pedicle instrumentation combined with decompression with nerve function damage can rebuild spinal stability,favorable neural functional recovery.
出处
《中国医师进修杂志》
2013年第32期8-11,共4页
Chinese Journal of Postgraduates of Medicine
关键词
脊柱骨折
内固定器
减压术
外科
神经功能损伤
Spinal fractures
Internal fixators
Deampression,surgical
Heurologic deficits
