后路椎体次全切减压重建与前后路联合手术治疗严重胸腰椎三柱骨折不全瘫的病例对照研究

目的 ：比较后路椎体次全切减压重建与前后路联合手术治疗严重胸腰椎三柱骨折的临床疗效,为术式选择提供依据。方法：对2008年1月至2012年12月采用后路椎体次全切减压重建（A组）和前后路联合手术（B组）治疗严重胸腰椎三柱骨折不全瘫33例患者的临床资料进行回顾性分析。其中A组18例,男10例,女8例;损伤节段：T111例,T125例,L16例,L26例。B组15例,男9例,女6例;损伤节段：T111例,T125例,L15例,L24例。采用Frankel分级评价神经功能;通过X线、CT评估伤椎前缘高度恢复情况、Cobb角的矫正情况、椎管减压范围及植骨融合情况。结果：所有患者得到随访,随访时间12~18个月,平均16个月。A组平均手术时间、术中出血量及术后引流量分别为（200±43）min,（1 100±344）ml及（400±112）ml;B组为（290±68）min,（1 500±489）ml及（900±269）ml,两组差异有统计学意义（P〈0.05）。伤椎前缘高度及后凸Cobb角术后较术前均有明显改善,但两组间比较差异无统计学意义（P〉0.05）。术后Frankel神经功能评分较术前均有1级或1级以上的改善,两组间比较差异无统计学意义（P〉0.05）。结论 ：后路椎体次全切减压、重建、椎弓根钉内固定通过1个切口完成了减压重建固定的效果,临床疗效与前后路手术相似,但创伤明显减少,是一种安全有效的手术方式。

Case-control study on therapeutic effects between posterior corpectomy,decompression and reconstruction and combined anterior-posterior surgery for the treatment of severe thoracolumbar fractures with incomplete paraplegia

Objective: To compare the clinical outcome between posterior corpectomy,decompression and reconstruction and combined anterior-posterior surgery in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia,and to provide a basis for procedure selection.Methods: Clinical and radiographic results of posterior corpectomy,decompression and reconstruction(group A) and combined anterior-posterior surgery(group B) in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia were analyzed retrospectively from January 2008 to December 2012. In group A,there were 18 patients (10 males and 8 females). The fractures were located on T₁₁ in 1 case,T₁₂ in 5 cases,L₁ in 6 cases and L₂ in 6 cases. In group B,there were 15 patients (9 males and 6 females). The fractures were located on T₁₁ in 1 case,T₁₂ in 5 cases,L₁ in 5 cases and L₂ in 4 cases. Neurological status was judged by Frankel grades. The X-ray and CT were used for evaluation of the restoration of anterior height of the fractured vertebral body,the correction of Cobbs angle,the decompression scope of spinal canal and the fusion. Complications related to operation were also considered.Results: The follow-up periods ranged from 12 to 18 months(averaged 16 months). The mean operation time,perioperative bleeding,postoperative drainage were (200±43) min,(1 100±344) ml,and (400±112) ml respectively in group A;and (290±68) min,(1 500±489) ml,(900±269) ml respectively in group B. There was statistically significant difference between groups A and B(P <0.05).There were significant improvements in anterior height of fractured vertebral body and Cobbs angle after operation. But there was no significant difference between groups A and B (P >0.05). In Frankel grades,all patients had one grade or more improvement postoperatively. There was no significant difference between two groups (P >0.05).Conclusion: Treatment of thoracolumbar vertebra burst fractures with subtotal vertebrectomy,decompression and reconstruction of anterior column through posterior approach has a similar clinical result compared to the operation through combined anterior and posterior approach,but the posterior surgery decreased surgical trauma. It is an effective and safe surgical method.