侧前方减压与后方减压治疗胸腰椎体爆裂性骨折的疗效比较

Comparison on curative effect between anterior decompression and posterior decompression in the treatment of thoracolumbar burst fracture

摘要:

目的：比较侧前方减压与后方减压手术治疗胸腰椎爆裂性骨折伴神经损伤的临床疗效。方法：2007年3月－2010年3月，共收治62例胸腰椎爆裂性骨折伴神经损伤，其中男43例，女19例；年龄22～68岁，平均42.3岁。采用随机对照方法平均分为2组，经前方椎管减压组（A组）美国脊髓损伤协会（American Spinal Injury Association，ASIA）分级[1]：C级19例，D级12例；经后方椎管减压（B组），ASIA分级：C级16例，D级15例。结果：62例患者随访时间2.0～3.5年，平均28个月；所有患者术后切口Ⅰ期愈合，椎管减压、复位满意，无脊髓损伤加重；内固定器无松动、脱落、断裂。A组出血量、手术时间与B组比较差异有统计学意义（t=11.175，t=13.748，P＜0.05）。A组术前椎管容积与B组比较差异无统计学意义（t=-1.092，P ＞0.05）；A组术后椎管容积、末次随访椎管容积与B组比较差异有统计学意义（t=2.411，t=1.934，P＜0.05）。A组术前、术后、末次随访椎体高度与B组相同时间点比较差异无统计学意义（t=-0.799，t=1.460，t=1.436，P ＞0.05）。A组术后2年神经损伤好转率为87.10%（27/31），与B组（77.45%、24/31）比较差异无统计学意义（χ2=0.995，P=0.800）。A组术后疼痛、医疗费用及住院时间与B组比较差异均有统计学意义（t=2.181，t=11.808，t=5.848，P＜0.05）。结论：严格掌握适应证，前方减压与后方减压治疗伴神经损伤的胸腰椎爆裂性骨折均能取得较好临床疗效；但后路减压手术操作相对简单，具有时间短、出血少、创伤小、费用低等优点，更适宜基层医院开展。

Abstract:

Objective：To compare curative effect between anterior decompression and posterior decompression in the treatment of tho－racolumbar burst fracture with neurologic deficit. Methods：From March 2007 to March 2010，62 cases of thoracolumbar burst fracture with neurologic deficit were treated. There were 43 males and 19 females with an average age of 42.3 years（22-68 years）. All cases were randomly divided into 2 groups：group A（anterior spinal canal decompression） and group B （posterior spinal canal decompres－sion）. According to American Spinal Injury Association（ASIA） standard，group A had 19 cases of C and 12 cases of D；group B had 16 cases of C and 15 cases of D. Results：Totally 62 cases were followed up for 2.0-3.5 years（28 months in average）. All wounds achieved primary healing postoperatively and all cases achieved satisfactory results in vertebral canal decompression and reduction. No loose－ness，protrution and breakage of internal fixator was observed. Blood loss was （675.3±124.1） ml in group A and （381.3±77.8） ml in group B，with statistically significant differences（t=11.175，P=0.000）. Operative time was （193.68±22.01） min in group A and （120.51±19.83） min in group B，with statistically significant differences（t=13.748，P=0.000）. Preoperative vertebral canal volume in group A was （43.05±8.53）% and （45.29±7.60）% in group B，without statistically significant differences（t=-1.092，P=0.279）. Post－operative vertebral canal volume in group A was （91.50±2.91）% and （89.81±2.60） % in group B，with statistically significant dif－ferences（t=2.411，P=0.010）. Vertebral canal volume in the last follow-up in group A was （91.89±2.16）% and （90.90±1.86）% in group B，with statistically significant differences（t=1.934，P=0.029）. Preoperative，postoperative and final vertebral heights in group A were （43.97±8.26）%，（90.45±2.26）%，（89.67±2.09）% and （45.48±6.52）%，（89.63±2.16）%，（88.95±1.85）% in group B，with－out statistically significant differences（t=-0.799，t=1.460，t=1.436，P＞0.05）. At 2 years postoperatively，27 cases in group A partly re－covered（curative rate of 87.10%） and 24 cases in group B partly recovered（curative rate of 77.45%），showing no statistically signifi－cant differences（χ2=0.995，P=0.800）. There were statistically significant differences in the postoperative pain，medical cost and time in hospital between groups A and B（t=2.181，t=11.808，t=5.848，P＜0.05）. Conclusions：Posterior decompression can achieve the same effects as anterior decompression in the treatment of thoracolumbar burst fractures with neurologic deficit as long as indications are strictly controlled. Posterior decompression is easier and has more merits than anterior decompression：shorter operative time，less blood loss，less damage，lower medical cost. Posterior decom－pression is more suitable for hospitals at primary level.