两种后路手术方式治疗胸腰椎爆裂性骨折的疗效比较

目的比较胸腰椎爆裂性骨折后路固定直接与间接减压两种手术方式的疗效,指导手术方案的合理选择。方法选取我院2007年1月~2011年1月收治的192例胸腰椎爆裂性骨折患者,随机分为直接减压组及间接减压组,各96例,分别接受后路固定直接及间接减压。比较两组患者手术及恢复情况。结果两组手术时间、术中出血量及24 h引流量比较均无统计学差异(P0.05),且均未见术后椎管内血肿、截瘫平面上升等严重神经功能损伤并发症;两组患者术后3个月伤椎高度丢失率、伤椎Cobb角及邻近椎间高度较术前均得到显著改善,差异具有统计学意义(P0.05),但两组间比较差异无统计学意义(P0.05);两组患者术后3个月Frankel分级比较差异无统计学意义(P0.05)。两组患者均获得有效随访,平均时间(1.7±0.4)年,直接减压组ODI评分为13.5%±2.9%,间接减压组为8.3%±1.6%,组间比较差异具有统计学意义(t=6.339,P0.05)。结论两种后路手术方式治疗胸腰椎爆裂性骨折均可有效改善患者的临床症状,且术中损伤小、术后并发症少,疗效及安全性均理想;直接减压易导致患者术后腰背功能恢复受到影响,治疗中应首选后路间接减压,在保证患者生活质量的前提下达到良好复位效果。

Effect Comparison of Posterior Internal Fixation with Direct and Indirect Decompression for Thoraco- lumbar Burst Fractures

Objective To compare the clinical efficacy of posterior internal fixation with direct and indi- rect decompression in the treatment of thoracolumbar burst fractures, and to guide the rational choice of surgical procedure. Methods A total of 192 cases with thoracolumbar burst fracture, collected in our hospital from January 2007 to January 2011, were randomly divided into direct decompression group and indirect decompres- sion group, with 96 cases for each. The internal fixation with direct decompress and indirect decompression were performed via posterior approach to the direct decompression group and indirect decompression group re- spectively. The operative duration, intra-operative blood loss, drainage volume during the 24 hours, post-opera- tive complication, involved vertebral recovery, Frankel grading of 3 months after the operation and Oswestry dis- ability index（ODI） of last follow-up were compared between two groups. Results There was no statistical difference in operation time, intra-operative blood loss and the drainage volume during the 24 hours between two groups （P 〉 O. 05）. And no post-operative complications such as intraspinal hematoma, paraplegia level rise and severe neurological complications were found. The loss rate of injured vertebrae height, Cobb angle and adjacent intervertebral height were improved obviously at the time of 3 months after the operation than those of pre-operation in both two groups （P 〈 0.05）, but there was no statistical difference between two groups （P 〉0.05 ）. No statistical difference was appeared in Frankel grade 3 months after operation between two groups （P 〉 0.05）. All cases were followed up for 1.7 ± 0.4 years averagely. The ODI of direct decompres- sion group was 13.5% ±2.9% , and was remarkable higher than 8.3% ± 1.6% of indirect decompres- sion group （t = 6. 339, P 〈 0. 05 ）, Conclusions Both direct and indirect decompression procedures via posterior approach can improve the clinical symptoms effectively and achieve a safe