發(fā)布時(shí)間：2018-03-23 12:38

  本文選題：前路減壓　切入點(diǎn)：后路減壓　出處：《中國(guó)現(xiàn)代醫(yī)學(xué)雜志》2017年20期

【摘要】：目的比較前、后路減壓2種方法治療胸腰段脊柱骨折合并脊髓受壓的療效,為臨床治療提供參考。方法選取2013年1月-2015年1月在該院就診的胸腰段脊柱骨折合并脊髓受壓60例患者作為研究對(duì)象,隨機(jī)將其分為實(shí)驗(yàn)組和對(duì)照組,實(shí)驗(yàn)組采取前路減壓內(nèi)固定治療,對(duì)照組采取后路減壓內(nèi)固定治療,所有手術(shù)均由同一治療小組完成。觀察并記錄兩組患者手術(shù)時(shí)間、術(shù)中出血量、切口大小及圍手術(shù)期并發(fā)癥,采用美國(guó)脊髓損傷協(xié)會(huì)(ASIA)運(yùn)動(dòng)評(píng)分及觸覺評(píng)分評(píng)估術(shù)前及術(shù)后1年神經(jīng)功能,行胸腰段X線評(píng)估術(shù)前及術(shù)后1年傷椎椎體高度、Cobb角及骨折愈合情況。結(jié)果治療前,兩組研究對(duì)象的ASIA運(yùn)動(dòng)評(píng)分、觸覺評(píng)分、傷椎椎體高度及Cobb角比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后1年,上述指標(biāo)均與術(shù)前比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。且實(shí)驗(yàn)組運(yùn)動(dòng)評(píng)分、感覺評(píng)分及傷椎椎體高度、Cobb角度均比對(duì)照組要高。實(shí)驗(yàn)組比對(duì)照組術(shù)中出血多,手術(shù)時(shí)間長(zhǎng),切口要長(zhǎng),圍術(shù)期并發(fā)癥發(fā)生的多。隨訪1年時(shí),兩組研究對(duì)象骨折均已愈合,無斷釘、斷棒、及釘棒拔出等情況。結(jié)論 2種手術(shù)方式均能提供脊柱堅(jiān)強(qiáng)的內(nèi)固定,利于骨折的愈合。相比較后路手術(shù)而言,前路減壓內(nèi)固定術(shù)能夠更好地減壓脊髓,促進(jìn)脊髓功能的恢復(fù),更好地改善神經(jīng)功能,但前路手術(shù)創(chuàng)傷大,出血稍多,需要更加細(xì)致的圍手術(shù)期準(zhǔn)備。
[Abstract]:Objective to compare the efficacy of anterior and posterior decompression in the treatment of thoracolumbar spinal fracture with spinal cord compression. Methods from January 2013 to January 2015, 60 patients with thoracolumbar spinal fracture combined with spinal cord compression were selected as study subjects and randomly divided into experimental group and control group. The experimental group was treated with anterior decompression and internal fixation, and the control group with posterior decompression and internal fixation. All the operations were performed by the same treatment group. The size of incision and perioperative complications were evaluated by ASIA motor score and tactile score before and 1 year after operation. Chest and lumbar X-ray were performed to evaluate the height of vertebral body and fracture healing before and one year after operation. Results before treatment, ASIA motor score, tactile score, vertebral height and Cobb angle were compared between the two groups. There was no significant difference (P 0.05). After 1 year of operation, the above indexes were significantly different from those before operation (P 0.05), and the motor score of the experimental group was higher than that of the control group (P < 0.05). The sensory score and the Cobb angle of the injured vertebra height were higher than those of the control group. The experimental group had more bleeding, longer operation time, longer incision and more perioperative complications than the control group. Conclusion both surgical methods can provide strong internal fixation of spinal column and facilitate fracture healing. Compared with posterior approach, anterior decompression and internal fixation are better for decompression of spinal cord. It can promote the recovery of spinal cord function and improve neurological function better, but the anterior approach is more traumatic and haemorrhagic, so more detailed perioperative preparation is needed.
【作者單位】： 新疆醫(yī)科大學(xué)第六附屬醫(yī)院脊柱外科;新疆醫(yī)科大學(xué)第六附屬醫(yī)院創(chuàng)傷骨科;
【分類號(hào)】：R687.3

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