前、后路内固定融合术治疗脊柱胸腰段骨折的比较研究

目的探讨比较脊柱前、后路内固定融合术治疗胸腰段骨折的临床疗效。方法笔者对2011年1月~2013年12月收治的90例胸腰段骨折患者的临床治疗及随访资料进行回顾性分析,按照手术方式采用前路内固定融合治疗(42例)和后路内固定融合术治疗(48例),统计分析两组患者的术中情况、术后不同时间的X线评价指标、美国脊柱损伤协会(ASIA)神经功能恢复及临床疗效差异。结果后路组的手术时间(147.3±38.7)min、术中出血量(607.5±162.3)m L、手术切口长度(10.3±1.8)cm、术后住院时间(10.6±2.0)d均显著低于前路组患者(P0.05)。术前、术后即刻两组患者的前缘高度比值、Cobb角测量值差异均不具有统计学意义(P0.05)。术后末次随访,后路组术后即刻伤椎前缘高度丢失(1.55±0.17)mm、Cobb角丢失(1.26±0.72)°,均显著低于前路组(7.18±1.51)mm、(7.43±1.85)°。术前、术后后路组和前路组ASIA分布差异不显著(P0.05);术后两组ASIA神经功能恢复分布较术前均显著好转(P0.05)。末次随访时,后路组患者的Oswestry功能障碍指数(ODI)优级率(77.08%)高于前路组(52.38%),良和差均显著低于前路组患者,后路组的ODI功能分布显著优于前路组(P0.05)。结论脊柱后路内固定融合术治疗胸腰段骨折较前路术创伤小、术后恢复快、Cobb角度丢失小,临床疗效更加可靠。

Anterior and posterior internal fixation and fusion surgery in the treatment of thoracolumbar fractures

Objective To investigate the efficacy of anterior and posterior internal fixation and fusion in treating thoracolumbar fractures .Methods The clinical treatment and follow-up data of 90 patients with thoraco-lumbar fractures in our hospital from Jan .2011 to Dec.2013 were retrospectively analyzed .The patients were divid-ed into anterior fixation group(42 cases) and posterior fixation group(48 cases).The intraoperative situation,post-operative X evaluation index at different time ,ASIA neural functional recovery and clinical efficacy of the two groups were statistically analyzed . Results The operation time ( 147.3 ± 38.7 ) min ] , the amount of intraoperative bleeding(607.5 +162.3)mL],incision length(10.3 ±1.8)cm],postoperative hospitalization time (10.6 ± 2)d] of the posterior group were significantly lower than those of the anterior group (P<0.05).The anterior height ratio,Cobb angle measurement values preoperatively and immediately after operation had no statistical significance (P>0.05).At the last follow-up after surgery,the anterior height loss of the vertebral anterior height was (1.55 ± 0.17) mm and the Cobb angle loss was (1.26 ±0.72)°in the posterior group,which were significantly lower than those of the anterior group(7.18 ±1.51)mm,(1.85 ±7.43)°].Before and after the operation,the distribution of ASIA in the posterior group and anterior group had no statistical difference ( P>0.05 ) .The distribution of ASIA nerve function recovery was significantly improved in the two groups after surgery (P<0.05).At the end of the fol-low-up,the excellent rate(77.08%) of the posterior group was higher than that of the anterior group (52.38%), the good and poor rate of the posterior group was significantly lower than that of the anterior group ,and the ODI func-tion distribution of the posterior group was significantly better than that of the anterior group (P<0.05).Conclu-sion Posterior internal fixation and fusion for treatment of thoracolumbar fractures has less trauma ,faster postopera-tive recovery ,smaller Cobb angle loss and more reliable curative effect .