胸腰段脊柱严重爆裂骨折前、后路器械不同固定方式疗效分析

目的 评价胸腰段脊柱严重爆裂骨折前、后路器械不同固定方式的临床疗效，为今后的治疗选择提供依据。方法 通过72例胸腰段脊柱严重爆裂骨折前路（前路组，34例）或后路（后路组，38例）器械不同固定方式的临床疗效及影像学观察，评判其脊柱矫形、椎管减压、坐立或行走时间、脊柱融合率及美国脊髓损伤协会（ASIA）神经功能分级等两组间差异。结果 随访时间后路组5个月－5年11个月，平均3年8个月；前路组2个月－4年5个月，平均2年4个月。前路组除出血较多外，其脊柱矫形、椎管减压、坐立或行走时间、脊柱融合率明显优于后路组，差异有显著性意义和非常显著性意义（P＜0．05和P＜0．01）。ASIA分级：后路组术前A级6例，B级7例，C级11例，D级14例；前路组术前A级8例，B级6例，C级5例，D组15例。两组术后ALIA分级：后路组A级3例，B级6例，C级8例，D级12例，E级9例；前路组A级2例，B级2例，C级3例，D级13例，E级14例。前路组ASIA分级平均增加1.8级，而后路组仅增加1.2级。结论 胸腰段脊柱严重爆裂骨折，以前路减压、Z-plate内固定及钛网技术为较佳治疗选择，值得进一步推广应用。

Clinical evaluation of anterior or posterior fixations in severe thoracolumbar burst fractures

Objective To evaluate the effects of anterior or posterior fixations in severe thoracolumbar burst fractures so as to provide a clinical evidence for adoption of treatment in thoracolumbar burst fractures. Methods A restrospective analysis was done in 72 cases with severe thoracolumbar burst fracture treated with anterior or posterior fixations. All the cases were further divided into two groups, anterior group (Group A, 34 cases) and posterior group (Group B, 38 cases). The outcome was assessed by clinical criteria and radiographs of the thoracolumbar spine. The effects of the anterior or posterior fixations were evaluated by analyzing spinal reduction, decompression of spinal canal, time of sitting or walking, fusion rate and American Spinal Injury Association (ASIA) impairment scale. Results The Group B was followed up for 5-71 months (average 44 months) and the Group A for 2-53 months (average 28 months). The Group A was better than the Group B in spinal reduction, decompression of spinal canal, time of sitting or walking and fusion rate except for hemorrhage. There existed a significant difference between the two groups (P<0.05 and P<0.01 ). ASIA scale in the Group B showed the following results: 6 cases were at scale A, 7 at B, 11 at C, 14 at D in preoperation and 3 at A, 6 at B, 8 at C, 12 at D, 9 at E in postoperation, respectively. ASIA scale in the Group A showed that 8 cases were at scale A, 6 at B, 5 at C, 15 at D in preoperation and 2 at A, 2 at B, 3 at C, 13 at D, 14 at E in postoperation, respectively. ASIA scale was increased for average 1.8 scale in the Group A and for only average 1.2 scale in the Group B. Conclusions Anterior operation with anterior decompression, network of titanium techniques and Z-plate systems is a valuable method and a better choice for treatment of thoracolumbar burst fracture. It is worth recommending for further employment.