不同手术方式治疗胸腰椎爆裂骨折合并脊髓损伤的临床疗效观察

目的 探讨急诊单侧椎弓根减压后路复位固定术治疗合并脊髓损伤的胸腰椎爆裂骨折的临床疗效.方法 对44例合并脊髓损伤的胸腰椎爆裂骨折患者进行手术治疗,观察组21例急诊应用单侧椎弓根减压后路复位固定术治疗,对照组23例择期应用伤椎椎弓根置钉后路复位固定术治疗,比较两组患者术后1周、12个月伤椎前缘高度、脊柱矢状位Cobb角度和椎管前后径,12个月评价神经功能恢复情况.结果 两组患者均成功完成手术,手术时间和术中出血量组间差异无统计学意义（P＞0.05）;术后1周、12个月时伤椎椎管前缘高度、脊柱矢状位Cobb角度组间比较差异均无统计学意义（P＞0.05）;观察组伤椎椎管前后径较治疗前增加,差异有统计学意义（P＜0.05）;对照组与治疗前比较差异无统计学意义（P＞0.05）,观察组改善情况优于对照组（P＜0.05）;术后12个月时观察组神经功能恢复有效率优于对照组（P＜0.05）.结论 急诊应用单侧椎弓根减压后路复位固定术治疗合并脊髓损伤的胸腰椎爆裂骨折,可在短时间内解除脊髓和神经压迫,恢复脊柱的稳定性,有利于神经功能的恢复,具有确切的近期和远期疗效.

Clinical effect of the timing and mode of the operation on thoracolumbar burst fracture associated with spinal cord injury

Objective To investigate the curative effect of emergency operation of unilateral pedicle decompression by posterior reduction and fixation in the treatment of thoracolumbar burst fracture associated with spinal cord injury.Methods 44 patients with thoracolumbar burst fracture associated with spinal cord injury （observation group） were treated with unilateral pedicle decompression by posterior reduction and fixation.23 patients （control group） were treated with vertebral pedicle screw posterior reduction and fixation.The anterior vertebral height,spinal sagittal Cobb angle and spinal canal diameter at 1st week and 12th month before and after the operation and the neurological function recovery at 12th month were evaluated.Results All patients were successfully completed the operation.The operation time and intraoperative blood loss between the two groups were no statistical significance （P〉 0.05）.The anterior vertebral canal height,spinal sagittal Cobb angle and spinal canal diameter at 1st week and 12th month after the operation showed no significant differences.The improvement of the observation group was better than that of the control group.12 months after operation,neural functional recovery efficiency of the observation group was better than that of the control group.The rate of functional recovery the observation group was higher than that of the control group.Conclusion It can relieve the compression of spinal cord and nerve in a short period of time and recover spinal stability and nervous function by emergency operation of unilateral vertebral pedicle decompression posterior reduction and fixation in the treatment of thoracolumbar burst fracture associated with spinal cord injury.