前、后路减压治疗胸腰段脊柱骨折合并脊髓受压的疗效对比研究

Curative effect of anterior and posterior decompression on thoracolumbar spine fractures complicated with spinal cord compression

摘要:

目的比较前、后路减压2 种方法治疗胸腰段脊柱骨折合并脊髓受压的疗效，为临床治疗提供参考。方法选取2013 年1 月-2015 年1 月在该院就诊的胸腰段脊柱骨折合并脊髓受压60 例患者作为研究对象，随机将其分为实验组和对照组，实验组采取前路减压内固定治疗，对照组采取后路减压内固定治疗，所有手术均由同一治疗小组完成。观察并记录两组患者手术时间、术中出血量、切口大小及围手术期并发症，采用美国脊髓损伤协会（ASIA）运动评分及触觉评分评估术前及术后1 年神经功能，行胸腰段X 线评估术前及术后1 年伤 椎椎体高度、Cobb角及骨折愈合情况。结果治疗前，两组研究对象的ASIA 运动评分、触觉评分、伤椎椎体高度及Cobb 角比较，差异无统计学意义（p >0.05）。术后1 年，上述指标均与术前比较，差异有统计学意义（p <0.05）。且实验组运动评分、感觉评分及伤椎椎体高度、Cobb 角度均比对照组要高。实验组比对照组术中出血多，手术时间长，切口要长，围术期并发症发生的多。随访1 年时，两组研究对象骨折均已愈合，无断钉、断棒、及钉棒拔出等情况。结论2 种手术方式均能提供脊柱坚强的内固定，利于骨折的愈合。相比较后路手术而言，前路减压内固定术能够更好地减压脊髓，促进脊髓功能的恢复，更好地改善神经功能，但前路手术创伤大，出血稍多，需要更加细致的围手术期准备。

Abstract:

Objective To compare the clinical curative effect of anterior decompression and posterior decompression on the treatment of thoracolumbar spine fractures complicated with spinal cord compression. Methods Sixty patients diagnosed as thoracolumbar spine fractures complicated with spinal cord compression between January 2013 and Jannuary 2015 were randomly divided into treatment group and control group. The treatment group was treated by anterior approach decompression and the control group was treated by posterior approach decompression. All the operations were completed by the same treatment team. The surgical time,intraoperative blood loss, length of incision and perioperative complications were recorded and compared. The American Spinal Injury Association (ASIA) motor function and tactile scores were used to evaluate neurological function before and 1 year after operation. Height of injured vertebral body, Cobb's angle and fracture healing were evaluated by X-ray. Results Before surgery, the ASIA motor and tactile scores, height of injured vertebral body and Cobb's angle of the treatment group were similar to those of the control group (p > 0.05).One year after surgery, those indexes were significantly differeent from the preoperative ones (p < 0.05); moreover,the values of the treatment group were signifiantly higher than those of the control group (p < 0.05). The intraoperative blood loss was more, the surgical time and length of incision were longer, and the incidences of perioperative complications were higher in the treatment group than in the control group ( < 0.05). All patients in this study achieved solid fusion after one year, and no broken nails, broken rods or stick out nails were observed. Conclusions Anterior approach decompression and posterior approach decompression are sufficient to provide stronge internal fixation for treatment of thoracolumbar fractures. Compared with posterior decompression,anterior decompression is more effective and better promotes spinal cord function. The anterior decompression induces more blood loss and trauma, therefore needs more careful perioperative preparation.