摘要
目的探讨微创同切口通道下减压术治疗伴有神经损伤的胸腰椎骨折的临床效果。方法选择2016年10月至2019年3月上海市公共卫生临床中心收治的96例伴有神经损伤的胸腰椎骨折患者为研究对象,根据手术方式分为观察组(n=56)和对照组(n=40),对照组患者采取开放性椎管减压术治疗,观察组患者采取微创同切口通道下减压术治疗。记录患者术中出血量、肌肉剥离长度、手术时间、术后引流量及住院时间;术前、术后6个月,采用视觉模拟评分法(VAS)评估患者疼痛情况;术前、术后1周和术后6个月,采用Oswestry功能障碍指数(ODI)评分评估患者脊柱功能;分别于术前和术后1周采用胸腰椎正侧位X线片测量伤椎椎体前、后缘相对高度及后凸Cobb角;观察患者术后1个月内并发症发生情况,术后6个月评估2组患者临床疗效。结果2组患者的手术时间比较差异无统计学意义(P>0.05);与对照组比较,观察组患者的术中出血量、术后引流量少,肌肉剥离长度小,住院时间短(P<0.05)。2组患者术前VAS评分比较差异无统计学意义(P>0.05),2组患者术后6个月VAS评分均显著低于术前(P<0.05);术后6个月,观察组患者VAS评分显著低于对照组(P<0.05)。2组患者术前ODI评分比较差异无统计学意义(P>0.05);2组患者术后1周、术后6个月ODI评分显著低于术前,术后6个月ODI评分显著低于术后1周(P<0.05);术后1周和6个月,观察组患者ODI评分显著低于对照组(P<0.05)。2组患者术前椎体前、后缘相对高度及Cobb角比较差异无统计学意义(P>0.05);与术前比较,2组患者术后1周椎体前、后缘相对高度增大,Cobb角减小(P<0.05);术后1周,观察组患者椎体前、后缘相对高度显著大于对照组,Cobb角显著小于对照组(P<0.05)。术后6个月,观察组和对照组患者总有效率分别为98.2%(55/56)、87.50%(35/40),观察组患者总有效率高于对照组(χ2=4.571,P<0.05)。术后1个月内,观察组和对照组患者并发症发生率分别为7.1%(4/56)、12.5%(5/40),观察组患者并发症发生率显著低于对照组(χ2=4.216,P<0.05)。结论微创同切口通道下减压术治疗伴有神经损伤的胸腰椎骨折疗效肯定,且创伤小,患者恢复快,术后并发症少。
Objective To explore the clinical effect of minimally invasive decompression through the same incision in the treatment of patients with thoracolumbar fractures and nerve injury.Methods Ninety-six patients with thoracolumbar fractures and nerve injury admitted to Shanghai Public Health Clinical Center from October 2016 to March 2019 were selected as the research subjects,and the patients were divided into observation group(n=56)and control group(n=40)according to the operation method.The patients in the control group were treated with open spinal canal decompression,while the patients in the observation group were treated with minimally invasive decompression through the same incision.The intraoperative blood loss,muscle dissection length,operation time,postoperative drainage volume and hospitalization time were recorded.The pain of the patients was evaluated by visual analogue scale(VAS)before and six months after operation.The spinal function was evaluated by Oswestry disability index(ODI)score at the time points of before operation,one week and six months after operation.The relative height of anterior and posterior margin of injured vertebrae and Cobb angle were measured by anteroposterior and lateral X-ray films of thoracolumbar spine before and one week after operation.The incidence of complications was observed within one month after operation,and the clinical effect of the patients in the two groups was evaluated at six months after operation.Results There was no significant difference in the operation time between the two groups(P>0.05).Compared with the control group,the intraoperative blood loss and postoperative drainage volume were less,the length of muscle dissection was small,and the hospitalization time was shorter in the observation group(P<0.05).There was no significant difference in the VAS score between the two groups before operation(P>0.05).The VAS scores at six months after operation were significantly lower than those before operation in the two groups(P<0.05).The VAS score in the observation group was significantly lower than that in the control group at six months after operation(P<0.05).There was no significant difference in the ODI score between the two groups before operation(P>0.05).The ODI scores at one week and six months after operation were significantly lower than those before operation,and the ODI scores at six months after operation were significantly lower than those at one week after operation(P<0.05).The ODI scores in the observation group were significantly lower than those in the control group at one week and six months after operation(P<0.05).There was no significant difference in the relative height of anterior and posterior margin of injured vertebrae and Cobb angle between the two groups before operation(P>0.05).Compared with before operation,the relative height of anterior and posterior margin of injured vertebrae increased,and the Cobb angle decreased at one week after operation(P<0.05).One week after operation,the relative height of anterior and posterior edge of vertebral body in the observation group was significantly higher than that in the control group,and the Cobb angle in the observation group was significantly smaller than that in the control group(P<0.05).Six months after operation,the total effective rate in the observation group and the control group was 98.2%(55/56)and 87.50%(35/40),respectively.The total effective rate in the observation group was higher than that in the control group(χ2=4.571,P<0.05).Within one month after operation,the incidence of complications in the observation group and the control group was 7.1%(4/56)and 12.5%(5/40),respectively.The incidence of complications in the observation group was significantly lower than that in the control group(χ2=4.216,P<0.05).Conclusion Minimally invasive decompression through the same incision is effective in the treatment of thoracolumbar fracture with nerve injury.It has the advantages of less trauma,faster recovery and fewer postoperative complications.
作者
沙宝学
罗涛
周威力
SHA Baoxue;LUO Tao;ZHOU Weili(Department of Orthopaedics,Shanghai Public Health Clinical Center,Shanghai 201500,China)
出处
《新乡医学院学报》
CAS
2020年第12期1143-1146,1151,共5页
Journal of Xinxiang Medical University
关键词
胸腰椎骨折
神经损伤
微创手术
椎管减压术
thoracolumbar fracture
nerve injury
minimally invasive surgery
spinal canal decompression
