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

发布时间：2018-03-23 12:38

本文选题：前路减压　切入点：后路减压　出处：《中国现代医学杂志》2017年20期

【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(P0.05)。术后1年,上述指标均与术前比较,差异有统计学意义(P0.05)。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 efficacy of anterior and posterior decompression in the treatment of thoracolumbar spinal fracture with spinal cord compression. Methods from January 2013 to January 2015, 60 patients with thoracolumbar spinal fracture combined with spinal cord compression were selected as study subjects and randomly divided into experimental group and control group. The experimental group was treated with anterior decompression and internal fixation, and the control group with posterior decompression and internal fixation. All the operations were performed by the same treatment group. The size of incision and perioperative complications were evaluated by ASIA motor score and tactile score before and 1 year after operation. Chest and lumbar X-ray were performed to evaluate the height of vertebral body and fracture healing before and one year after operation. Results before treatment, ASIA motor score, tactile score, vertebral height and Cobb angle were compared between the two groups. There was no significant difference (P 0.05). After 1 year of operation, the above indexes were significantly different from those before operation (P 0.05), and the motor score of the experimental group was higher than that of the control group (P < 0.05). The sensory score and the Cobb angle of the injured vertebra height were higher than those of the control group. The experimental group had more bleeding, longer operation time, longer incision and more perioperative complications than the control group. Conclusion both surgical methods can provide strong internal fixation of spinal column and facilitate fracture healing. Compared with posterior approach, anterior decompression and internal fixation are better for decompression of spinal cord. It can promote the recovery of spinal cord function and improve neurological function better, but the anterior approach is more traumatic and haemorrhagic, so more detailed perioperative preparation is needed.
【作者单位】：新疆医科大学第六附属医院脊柱外科;新疆医科大学第六附属医院创伤骨科;
【分类号】：R687.3

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