后路减压植骨融合椎弓根内固定治疗胸腰椎爆裂骨折的临床疗效

摘要

Objective: To evaluate the clinical effect of posterior decompression and fusion pedicle screw fixation treating in thoracolumbar burst fracture.Methods: 120 cases of thoracolumbar burst fracture patients were divided into anterior approach surgery group (27 cases) and posterior approach surgery group (93 cases).The prognosis of the two groups were compared.Results: The average bleeding quantity of posterior group [(350±100) ml was less than that of anterior group [(1 100±150)ml], and there was a significant difference between the two groups (t=29.853, P＜0.01).Average surgery time of posterior group [(70±10)min]was shorter than that of anterior group [(145±30)min], and there was a significant difference between the two groups (t=31.291, P＜0.01).The rate of bone fusion 2 years after operation of posterior group (19.2％) were lower than that of anterior group (63.0％), and there was a significant difference between the two groups (x2=28.61, P＜0.01).2 years after operation, nerve function of posterior group mostly improved 1 to 3 levels compared with preoperative, and the original neurological symptoms did not increased, and without any new neurological symptoms.Conclusion: Compare with the anterior approach surgery, the posterior approach surgery has less bleeding, simple, short time, low long-term fusion rate and so on as advantages, and with the same effect.But it should keep integrity of posterior longitudinal ligament.In the treatment of thoracolumabar burst fracture, posterior decompression can be recognized as a prior choice according to the condition of patients.%目的:研究后路减压植骨融合椎弓根内固定疗法在胸腰椎爆裂骨折治疗中的临床疗效.方法:选择120例胸腰椎爆裂骨折患者,分为前路手术治疗组(27例)与后路手术治疗组(93例).对比两组的预后情况.结果:后路手术组平均出血量[(350±100)ml]少于前路手术组[(1 100±150)ml],差异有高度统计学意义(t=29.853,P<0.01).后路手术组平均手术时间[(70±10)min]短于前路手术组[(145±30)min],差异有高度统计学意义(t=31.291,P<0.01).术后2年后路手术组植骨融合率(19.2%)低于前路手术组(63.0%),差异有高度统计学意义(χ2=28.61,P<0.01).比较后路手术组手术前后ASIA神经功能分级结果提示,后路手术组患者术后2年的脊髓神经功能与术前相比改善1～3级,且无一例患者发生原有神经症状加重,无一例患者发生新的神经症状.结论:后路手术同前路手术相比,具有出血量少、手术操作简单、手术时间短,远期植骨融合率低等优势,疗效基本一致,但需要保持后纵韧带的完整性.在胸腰椎爆裂性骨折治疗中,可根据患者具体情况,优先选择后路手术.