摘要
目的通过比较前后联合入路和单纯前路减压融合固定治疗不稳定性胸腰椎骨折的疗效，探讨不稳定性胸腰椎骨折的更佳手术方法。方法回顾性分析2006年2月至2012年6月收治的55例单节段不稳定性胸腰椎骨折患者资料，根据手术入路不同分为单纯前路组（27例，采用单纯经前路重建治疗）和前后联合组（28例，采用前路减压融合联合后路开放椎弓根置钉固定治疗）。通过比较两组患者术后3、12个月的疼痛视觉模拟评分（VAS）、健康调查简表（sF-36）、日本矫形外科协会（JOA）下腰痛评分、Oswestry残疾障碍指数（ODI）、伤椎前缘高度丢失率、后凸cobb角、伤椎矢状楔形角、椎管占位率的矫正情况评估效果，观察术后12个月神经功能美国脊髓损伤协会（ASIA）分级改善情况以评估神经功能恢复程度。结果两组患者的手术时间、术中出血量、术后引流量比较差异均无统计学意义（P〉0．05）。术后3个月前后联合组患者的VAS和JOA评分优于单纯前路组，术后12个月前后联合组患者的VAS评分、后凸cobb角、伤椎楔形角和ASIA分级提高等级优于单纯前路组，以上比较差异均有统计学意义（P〈0．05）。两组患者间术后3、12个月其他指标比较差异均无统计学意义（P〉0．05）。所有患者术后3、12个月的各项指标均较术前改善，差异有统计学意义（P〈0．05）。结论前后联合入路较单纯前路手术具有术中即刻和术后长久维持满意复位效果，显著持续提高神经功能，结合后路辅助复位固定和前路支撑确切减压的双重优势，是治疗合并不完全性神经功能损害和后柱韧带复合体损伤的单节段不稳定性胸腰椎骨折安全、可靠的选择。
Objective To compare the clinical efficacy of anteroposterior approach （APA） versus anterior approach （AA） for decompression, fusion and fixation for single-level unstable thoracolumbar vertebrae fractures concomitant with incomplete neurologic symptoms and injury to posterior ligament complex （PLC）. Methods From February 2006 to June 2012, 55 patients were treated for single-level unstable thoracolumbar vertebrae fractures. Of them, 27 were treated by only anterior decompression and lateral screw-rod instrumentation and 28 by anterior decompression and fusion combined with open posterior pedicle fixation of one to two segments above and below the fracture position. The 2 groups were compared at postoperative 3 and 12 months in terms of visual analogue scale （VAS）, overall score of short-form health survey （SF-36）, Japanese Orthopaedics Association （JOA） score of lower back, Oswestry disability index （ODI）, loss ratio of anterior margin of vertebral height, endplate angle of kyphotic deformity of superior-inferior ad- jacent vertebrae, wedge angle of fractured vertebra via radiographic measurement and canal compromise rate. The neurologic functional recovery was analyzed using the American Spine Injury Association （ASIA） evaluation system at postoperative 12 months. Results There were no significant differences in operative time, amount of blood loss or postoperative drainage between the 2 groups （ P 〉 0. 05）. At postoperative 3 months, the VAS and JOA scores in the APA group were significantly better than those in the AA group （ P 〈 0. 05）. At 12 months after surgery, the VAS, kyphotic angle of adjacent vertebra, wedge angle of fractured vertebra and the ASIA improvements in the APA group were significantly better than those in the AA group （ P 〈 0. 05）. There were no significant differences between the 2 groups in the other indexes at postoperative 3 or 12 months （ P 〉 0. 05）. All the comparative indexes were significantly improved than the preoperative va
作者
巩腾
苏学涛
夏群
王景贵
阚世廉
Gong T;Kan SL;Su XT;Xia Q;Wang JG(Department of Orthopaedics, Tianfin Hospital, Tianfin 300211, China;The Affiliated Hospital to Logistics College of Chinese People＇s Armed Police Force, Tianjin 300162, China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2018年第4期303-311,共9页
Chinese Journal of Orthopaedic Trauma
基金
中国人民武装警察部队后勤学院博士启动项目（WYB201109）
关键词
胸椎
腰椎
骨折
骨折固定术
内
手术入路
Thoracic vertebrae
Lumbar vertebrae
Fracture, bone
Fracture fixation, internal
Surgical approach
