保守治疗与后路手术治疗胸腰椎A型骨折的疗效观察

目的观察无神经损伤同时伴椎管侵占的胸腰椎A型骨折保守治疗与后路手术治疗的中长期疗效并验证胸腰椎骨折严重性评分TLICS（Thoracolumbar Injury Classification and SeverityScore）分型系统评分对治疗方式选择的指导意义。方法 2002-01-2007-10我院收治74例无神经损伤胸腰椎A型骨折,分别接受保守治疗和后路手术治疗,随访并应用TLICS评分系统对病例进行评分。收集观察患者入院时、术后即时、及末次随访时X线片及CT片,测量侧位X线片上椎体复位情况,对腰背痛等指标于入院时、术后1个月、术后3个月及末次随访时采用目测类比评分（visualanalogue scale,VAS）,比较两组病例末次随访时工作能力恢复情况,并对数据进行统计学分析。结果两组随访时间及VAS评分及恢复工作比例,组间差异无显著性（P〉0.05）;其余指标（如：平均卧床时间、平均恢复工作时间、平均住院费用、椎体前高、椎体后高、Cobb角、椎管侵占率）差异有显著性意义（P〈0.05）。结论 （1）无神经损伤胸腰椎A型爆裂骨折手术治疗在早期改善症状、缓解疼痛及矫正畸形等方面明显好于保守治疗。（2）无神经损伤胸腰椎A型爆裂骨折手术治疗和保守治疗的中长期功能结果相似。（3）无神经损害的TLICS分型系统评分为4分的胸腰椎A型爆裂骨折,保守治疗和手术治疗均可作为治疗的选择。

A observation of therapeutic effect on thoracolumbar fractures of type A by the methods of conservative treatment or posterior-instrumentation fixation

Objective To observe the intermediate stage and long-term results of nonoperative treatment versus posterior-instrumentation fixation using pedicle screws techniques of traumatic thoracolumbar fractures of type A and test the reliability of TLICS.Methods 74 patients who were suffered from traumatic thoracolumbar burst fractures were studied retrospectively from Jan.2002 to Oct.2007.The TLICS has been used to access the thoracolumbar fracture.Unified criterion were used to both.Neurological deficits were not found in all patients.But the spinal canal invasion was found in all candidates by CT scanning.The patients were followed 2～7 years（average 4.2 years）and assessed by clinical and radiologic outcomes.The plain photographs and CT scans were analyzed on admission and the final follow-up.The local kyphosis angle was measured on the lateral plain photographs.The reduction of vertebrae,the local kyphosis angle,VAS scores and the recovery of spinal canal invasion were used to evaluate the results.The ultimate data were analyzed by SPSS 13.0 package of software.Results No significant devation of follow-up time、VAS scores and recovery-rate of work were found between the operative and nonoperative group（P0.05）,significant devation were found in the other paraments（eg：the mean time of lying in bed,the mean time of return to work,the mean cost of hospitalization,the anterior and posterior height of vertebrae,the local kyphosis angle,the extent of spinal canal invasion）（P0.05）.Conclusion（1）The early therapeutic effect of traumatic thoracolumbar burst fractures in the surgical group is better than that of the nonsurgical group such as pain relief,early activity and kyphosis correction.（2）the long-term functional outcome of therapeutic traumatic thoracolumbar burst fractures in the surgical and nonsurgical groups is similan.（3）Nonoperative treatment and posterior-instrumentation fixation are alternative method for traumatic thoracolumbar burst fractures which is evaluatedas 4 marks by TLICS.