胸腰椎爆裂性骨折手术时间的选择

目的:探讨胸腰椎爆裂性骨折手术时间的选择。方法:胸腰椎爆裂性骨折病人均采用手术治疗,根据脊髓损伤的病理生理过程,将患者按伤后手术时间0～3d、4～7d、7d以后分为A、B、C3个实验组,将3组患者的神经恢复程度进行比较。脊髓损伤的神经功能评分按AISA2000标准进行评分。结果:35例病人均获随访,随访时间为13～20个月,平均11个月。伴有脊髓神经损伤的胸腰椎爆裂性骨折伤后手术时间与术后患者神经恢复程度:A组术后神经功能较术前显著恢复,B组术后神经功能较术前显著恢复,差异有统计学意义(P<0.05)。C组术后神经功能恢复较差,较术前差异无统计学意义(P>0.05)。A组与C组术后神经功能恢复差异有统计学意义(P<0.05);B组与C组术后神经功能恢复差异有统计学意义(P<0.05);A组与B组相比较,术后神经功能恢复差异有统计学意义(P<0.05),A组术后神经功能恢复较B组明显。结论:手术治疗有显著的疗效,伤后手术时间越早,术后脊髓神经功能恢复越好;伤后7d以后手术,术后脊髓神经功能恢复差;手术应在7d内进行,条件允许的情况下,伤后手术时间越早越好。但由于急症手术存在一些问题,我们认为4～7d左右进行手术较为合适。

The choice of operation time after injury in thoracolumbar blowout fracture

Objective To discuss the choice of operation time after injury in thoracolumbar blowout fracture. Method The patients with thoracolumbar blowout fracture were all treated with operation and according to the operation time after injury, they were divided into three groups, group A (within 3 days), group B (4～7 days) and group C (more than 7 days). We compared the spinal nerve function recovery degree of the three groups and the degree of nervous function was pressed by the standard of AISA 2000. Results 35 cases were all followed up during the time of 13 to 20 months (the average time of 11 months). The relationship between the surgical operation time after injury and the degree of spinal nerve function recovery was as follows: the spinal nerve function was significantly recovered after treatment in group A and group B (P<0.05), while that in group C was not significant (P>0.05). Compared group A with group C, group B with group C and group A with group B, the degrees of spinal nerve function recovery were all statistically significant (P<0.05). Conclusion The surgical operation has obvious effect and the earlier the operation after injury is conducted, the better nervous function recovery is got. The recovery effect is poor when operation is done more than 7 days after injury, so the operation should be carried on within 7 days. If the condition allows, the operation should be done as early as possible, but emergency operation exists some problems, we think that surgical operation should be carried on 4～7 days after injury.