减压和非减压治疗无神经症状椎管内占位胸腰椎骨折的对比研究

发布时间：2018-10-12 11:24

【摘要】：目的比较后路开窗减压与非减压手术治疗无神经症状椎管内占位胸腰椎骨折的疗效。方法回顾分析2008年10月—2015年10月收治的符合选择标准的97例椎管受压占椎管面积1/3~1/2的无神经症状胸腰椎骨折患者,其中采用后路开窗减压手术51例(减压组),采用后路非减压手术46例(非减压组)。两组患者性别、年龄、致伤原因、受伤节段、胸腰椎损伤分类及严重程度评分(TLICS)、合并伤、受伤至手术时间以及术前伤椎前缘相对高度、后凸Cobb角、椎管受压占椎管面积百分比、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、日本骨科协会(JOA)评分等一般资料比较,差异均无统计学意义(P0.05),具有可比性。记录并比较两组患者手术时间、术中出血量、术后引流量、术后卧床时间、住院时间;术前、术后3 d及术后1年伤椎前缘相对高度、后凸Cobb角、椎管受压占椎管面积百分比及VAS评分、ODI、JOA评分。结果非减压组手术时间、术中出血量及术后引流量均明显少于减压组(P0.05);两组术后卧床时间和住院时间比较差异无统计学意义(P0.05)。减压组有4例发生术后脑脊液漏,经保守治疗后治愈;两组切口均Ⅰ期愈合,均未发生神经损伤、切口感染并发症。所有患者均获随访,随访时间10~18个月,平均11.7个月。两组椎体高度恢复满意,均无继发后凸畸形及继发神经症状加重。两组术后3 d及1年各影像学指标及疗效评分均较术前显著改善,差异有统计学意义(P0.05);术后1年两组椎管受压占椎管面积百分比、VAS评分、ODI均显著低于术后3 d(P0.05),JOA评分均显著高于术后3 d(P0.05);术后1年伤椎前缘相对高度非减压组显著高于术后3 d(P0.05),减压组与术后3 d比较差异无统计学意义(P0.05)。除术后3 d非减压组椎管受压占椎管面积百分比及JOA评分高于减压组,VAS评分和ODI显著低于减压组,比较差异有统计学意义(P0.05)外,其余指标组间比较差异无统计学意义(P0.05)。结论与后路开窗减压手术相比,后路非减压手术具有术中出血少、手术创伤小、术后疼痛轻等优点;在严格掌握手术适应证情况下,后路非减压手术是治疗椎管内占位达椎管面积1/3~1/2的无神经症状胸腰椎骨折有效方法之一。
[Abstract]:Objective to compare the effect of posterior fenestration decompression and non-decompression in the treatment of non-neurotic thoracic and lumbar spinal fractures. Methods from October 2008 to October 2015, 97 patients with thoracolumbar fractures without neurologic symptoms, who were treated with compression of spinal canal area of 1 / 3 / 1 / 2 of spinal canal area, were retrospectively analyzed. Posterior fenestration was performed in 51 cases (decompression group) and posterior non-decompression operation in 46 cases (non-decompression group). Sex, Age, cause of injury, Segment of injury, Classification of Thoracolumbar vertebrae injury and severity score (TLICS), combined injury, time from injury to surgery, relative height of anterior edge of injured vertebrae, kyphosis Cobb angle, spinal canal compression as a percentage of spinal canal area. Pain visual analogue score (VAS), Oswestry dysfunction index (ODI), Japan Orthopedic Association (JOA) score and other general data differences were not statistically significant (P0.05) comparable. The operation time, intraoperative bleeding volume, postoperative drainage volume, postoperative bed rest time and hospitalization time were recorded and compared between the two groups, the anterior edge of the injured vertebrae was relatively high and the kyphosis Cobb angle was 1 year before operation, 3 days after operation and 1 year after operation. Spinal canal compression as a percentage of spinal canal area, VAS score, ODI,JOA score. Results in the non-decompression group, the operative time, blood loss and postoperative drainage volume were significantly lower than those in the decompression group (P0.05), but there was no significant difference between the two groups in bed rest time and hospitalization time (P0.05). In the decompression group, cerebrospinal fluid leakage occurred in 4 cases and was cured after conservative treatment. All patients were followed up for 10 ~ 18 months (mean 11.7 months). There was no secondary kyphosis and secondary nerve symptom aggravation in both groups. The imaging indexes and curative effect scores of the two groups were significantly improved 3 days and 1 year after operation compared with those before operation. The percentage of vertebral canal compression to spinal canal area, VAS score and ODI were significantly lower than 3 days after operation (P0.05), JOA score was significantly higher than that of postoperative 3 days (P0.05); 1 year after surgery, the anterior vertebral anterior edge of the non-decompression group was significantly higher than that of the non-decompression group (P0.05). At 3 days after operation (P0.05), there was no significant difference between decompression group and postoperative 3 days (P0.05). Except that the percentage of vertebral canal compression area and JOA score in non-decompression group were higher than that in decompression group, VAS score and ODI score were significantly lower than those in decompression group (P0.05), but there was no significant difference between other groups (P0.05). Conclusion compared with posterior fenestration decompression surgery, posterior non-decompression surgery has the advantages of less intraoperative bleeding, less surgical trauma and less postoperative pain. Posterior non-decompression surgery is one of the effective methods for the treatment of nonsymptomatic thoracolumbar fractures with an area of 1 / 3 / 1 / 2 of the spinal canal.
【作者单位】：中山大学附属第五医院脊柱外科;
【分类号】：R687.3

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