前、后路手术治疗胸腰段爆裂骨折的疗效比较

目的评价前、后路手术治疗胸腰段爆裂骨折的效果及特点。方法1999年9月～2004年11月,对43例平均年龄为30.4岁的胸腰椎爆裂骨折患者根据伤情选择手术方式,17例采用前路手术,26例采用后路手术。术前神经功能按Frankel分级评定:A级3例,B级12例,C级19例,D级9例。结果所有患者获平均36.7个月(8～51个月)随访。术后伤口均一期愈合,未出现神经损伤症状加重等严重并发症。除3例完全性截瘫患者神经功能无变化外,其余病例均获较明显改善,前、后路手术Frankel分级分别改善1.6、1.3级。结论前、后路手术各有其特点,前路手术减压更为充分,术后脊柱序列维持较好。

Comparison between anterior and posterior surgical treatments of thoracolumbar burst fractures

Objective To discuss the results and characteristics of surgical treatments through anterior or posterior approach for thoracolumbar burst fractures. Methods The retrospective review included 43 cases with an average age of 30.4 years from September, 1999 to November, 2004. The surgical approach was chosen according to conditions of the injury. 17 cases received an anterior approach operation. The Frankel scale was used for assessment of nerve function. 3 cases were rated as Grade A, 12 as Grade B, 19 as Grade C, and 9 as Grade D before surgery. Results The mean follow-up period was 36.7 months. There were no severe postoperative complications, such as deterioration of nerve function. All the cases showed notable improvement. Except in 3 cases of complete paraplegia, the improvement was 1.6 and 1.3 Frankel grades respectively for the anterior and posterior approach operations. Conclusions The anterior and posterior approaches are different in advantages and characteristics. The surgery through anterior approach provides more decompression and better maintenance of sagittal plane alignment.