胸腰椎骨折手术方式及时间选择

目的：分析和比较不同减压术对胸椎骨折病人神经症状的改善及减压效果。方法：以1990年－1999年在夏旦大学附属中山医院进行手术的120例胸腰椎骨折病人为研究对象。分析手术前后的Frawnkel分级的变化、脊椎减压程度、手术方式及手术时间和失血量等因素。结果：手术后病人的减压效果比后路减压术明显，92％的病人能完全减压，但前路减压术的手术时间较长、术中失血量较大。创伤发生到手术的间隔时间小于4d失血量大，创伤4d后手术血量明显低于早期手术者。手术失量少者术后神经症状较大。结论：减压术能有效地改善胸腰椎骨折病人的神经症状，有明显的减压效果。前路术的减压效果较好，但手术时间较长、术中失血量较大。创伤4d后手术可减少手术中失血，有利于病人的恢复。合理的手术时间为创伤后4－14d。

The Kind of Surgery and Time Choice of Thoracolumbar Fracture

Objective: To describe and compare the improvement of neurological deficits and descompression of thoracolumbar fracture after anterior and posterior approach surgery. Methods: 120 thoracolumbar fracture patients operated with anterior or/and posterior decompression and instrumentation during 1990 to 1999 in Shanghai Zhongshan Hospital were included in this study. Frankel grading system was used to assess the neuological deficits. The Frankel grades, compression, blood loss and time useage in operation were analysed. Computed tomography scans were obtained to assess the spinal canal dimensions. Results: After surgery, the neurological deficits were improved, the average Frankel grade points was improved from 2.1 pre-operation to 3.1 post-operation( P <0.001). The average decompression in anterior approach was higher than in posterior approach (40% vs 11%, t=9.96, P =0.00). However, the blood loss and time usage in anterior approach was more than in posterior approach. The comparison of bleeding amount among various interval of injury and surgery showed early operation with more blood loss. The amount of bleeding in operation was associated with the neurological prognosis. Conclusion: It is necessary to decompression and instrumentation to the thoracolumbar fracture with neurological deficits by bone fragments in the spinal canal. The operative time after injury is associate with bleeding.