Objective To explore the clinical effect of the anterior and posterior surgical approach in the treatment of thoracolumbar burst fracture.Methods A total of 60 patients with thoracolumbar burst fracture who were admitted in our hospital from March,2015 to February, 2016 were included in the study and divided into the anterior group and posterior group with 30 cases in each group according to different surgical methods.The patients in the anterior group were given internal fixation,while the patients in the posterior group were given pedicle screw system treatment.The operation time,blood loss,drainage volume,and total fusion time were recorded.CT was used to measure the anteroposterior diameter and cross-sectional area of spinal canal before operation,1 week and 1 year after operation.Cobb's angle change value before operation,immediately after operation,and 1 year after operation was observed.American Spinal Inj ury Association(ASIA)was used to evaluate the neurological function recovery 1 year after operation.Results The intraoperative blood loss and postoperative drainage volume in the anterior group were significantly greater than those in the posterior group,while the operation time and fusion time were significantly longer than those in the posterior group(P<0.05).The spinal canal stenosis degree 1 week and 1 year after operation in the two groups was significantly improved when compared with before operation(P<0.05).The comparison of spinal canal stenosis 1 week after operation between the two groups was not statistically significant(P>0.05).The recovery of spinal canal stenosis 1 year after operation in the anterior group was significantly superior to that in the posterior group(P<0.05),there was a statistically significant in the interactions between groups,time points,groups and time points.Cobb's angle after opeation in the two groups was significantly reduced when compared with before operation(P<0.05),there was a statistically significant in the interactions between groups,time points, groups and time points.Cobb's angle loss 1 year after operation in the anterior group was significantly superior to that in the posterior group(P<0.05).ASIA grading 1 year after operation in the two groups was significantly superior to that before operation(P<0.05). Conclusion The great Cobb's angle loss is the disadvantage of pedicle screw system therapy, while the internal fixation has a long operation time and large trauma,but the postoperative spinal canal stenosis degree is small,and Cobb's angle loss is less.Due to the advantages and disadvantages for the two surgical methods,the patients should select the appropriate surgical methods according to the specific circumstance.%目的 探讨脊柱前路与后路手术治疗胸腰椎爆裂性骨折的临床效果.方法 选取胸腰椎爆裂性骨折患者60例,根据手术方式分为前路组和后路组各30例,分别采用脊柱前路内固定器系统和后路椎弓根钉棒系统治疗.记录2组手术时间、出血量、引流量、完全融合时间,应用 CT测量术前、术后1周及术后1年椎管前后径和横断面积,观察术前、术后即刻及术后1年 Cobb's 角变化值,参照美国脊柱损伤协会(American Spinal Inj ury Association,ASIA)标准评估术后1年神经功能恢复情况.结果 前路组术中出血量、术后引流量多于后路组,手术时间、融合时间长于后路组(P<0.05).术后1周、1年2组椎管狭窄程度均较术前改善,前路组术后1年椎管狭窄程度恢复优于后路组,其组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05).术后2组 Cobb's 角均小于术前,前路组术后1年 Cobb's 角小于后路组,其组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05);前路组术后1年Cobb's 角丢失小于后路组(P<0.05).术后1年2组 ASIA 分级均优于术前(P<0.05).结论 脊柱后路椎弓根钉棒系统不足之处是术后 Cobb's 角丢失较大,脊柱前路内固定器系统虽然手术时间长、创伤大,但术后椎管狭窄程度轻、Cobb's角丢失少,2种术式各有优缺点,应根据患者具体情况选择合适的手术方式.
展开▼
