中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2013年
4期
345-348
,共4页
史玉林%王炳武%伦登兴%赵常海
史玉林%王炳武%倫登興%趙常海
사옥림%왕병무%륜등흥%조상해
胸腰椎骨折%手术治疗%预后
胸腰椎骨摺%手術治療%預後
흉요추골절%수술치료%예후
Thoracolumbar fractures%Surgical treatment%Prognosis
背景：目前手术治疗胸腰椎骨折的方法较多，如后路、前路及前后路联合手术等。但对手术时机的选择仍存在较多的争议。<br> 目的：探讨胸腰椎骨折合并脊髓神经损伤的手术时机与术后改善率及手术并发症等的关系。<br> 方法：回顾性分析我院2009年3月至2012年1月手术治疗的84例胸腰椎骨折并脊髓神经损伤患者，其中男60例，女24例。年龄20~60岁，平均40.8岁。压缩骨折58例，爆裂骨折26例。对术后改善率、优良率、VAS评分、手术时间、出血量及手术相关并发症等因素进行分析。<br> 结果：所有患者平均随访19.4个月（11.5~36个月）。损伤后72 h内手术32例（38.1%）分入A组；72 h后手术52例（61.9%）分入B组。两组比较术后改善率、VAS评分无明显差异（P>0.05）。与72 h后手术组比较，72 h内手术组的优良率显著增高（P<0.05），但手术时间长、出血量多（P<0.01）。手术时机与并发症无显著相关性（P>0.05）。<br> 结论：对于脊髓神经损伤较重的胸腰椎骨折患者早期手术治疗可取得较理想的效果，但应充分考虑出血多、手术时间长及其他危险因素，权衡利弊个体化选择治疗方案。
揹景：目前手術治療胸腰椎骨摺的方法較多，如後路、前路及前後路聯閤手術等。但對手術時機的選擇仍存在較多的爭議。<br> 目的：探討胸腰椎骨摺閤併脊髓神經損傷的手術時機與術後改善率及手術併髮癥等的關繫。<br> 方法：迴顧性分析我院2009年3月至2012年1月手術治療的84例胸腰椎骨摺併脊髓神經損傷患者，其中男60例，女24例。年齡20~60歲，平均40.8歲。壓縮骨摺58例，爆裂骨摺26例。對術後改善率、優良率、VAS評分、手術時間、齣血量及手術相關併髮癥等因素進行分析。<br> 結果：所有患者平均隨訪19.4箇月（11.5~36箇月）。損傷後72 h內手術32例（38.1%）分入A組；72 h後手術52例（61.9%）分入B組。兩組比較術後改善率、VAS評分無明顯差異（P>0.05）。與72 h後手術組比較，72 h內手術組的優良率顯著增高（P<0.05），但手術時間長、齣血量多（P<0.01）。手術時機與併髮癥無顯著相關性（P>0.05）。<br> 結論：對于脊髓神經損傷較重的胸腰椎骨摺患者早期手術治療可取得較理想的效果，但應充分攷慮齣血多、手術時間長及其他危險因素，權衡利弊箇體化選擇治療方案。
배경：목전수술치료흉요추골절적방법교다，여후로、전로급전후로연합수술등。단대수술시궤적선택잉존재교다적쟁의。<br> 목적：탐토흉요추골절합병척수신경손상적수술시궤여술후개선솔급수술병발증등적관계。<br> 방법：회고성분석아원2009년3월지2012년1월수술치료적84례흉요추골절병척수신경손상환자，기중남60례，녀24례。년령20~60세，평균40.8세。압축골절58례，폭렬골절26례。대술후개선솔、우량솔、VAS평분、수술시간、출혈량급수술상관병발증등인소진행분석。<br> 결과：소유환자평균수방19.4개월（11.5~36개월）。손상후72 h내수술32례（38.1%）분입A조；72 h후수술52례（61.9%）분입B조。량조비교술후개선솔、VAS평분무명현차이（P>0.05）。여72 h후수술조비교，72 h내수술조적우량솔현저증고（P<0.05），단수술시간장、출혈량다（P<0.01）。수술시궤여병발증무현저상관성（P>0.05）。<br> 결론：대우척수신경손상교중적흉요추골절환자조기수술치료가취득교이상적효과，단응충분고필출혈다、수술시간장급기타위험인소，권형리폐개체화선택치료방안。
Background:There are many surgical treatments for thoracolumbar fracture, such as posterior approach, anterior approach and combied approach. But the choice of surgical intervention timing is still controversal. <br> Objective:The goal of this study is to investigate the relationships between surgical intervention timing and post-operative recovery rate, and complications in patients with thoracolumbar fractures combined with neurological deficit. <br> Methods:Eighty-four patients with thoracolumbar fractures and neurological deficit underwent surgical treatment between March 2009 and January 2012 and were enrolled in this study. There were 60 males and 24 females with a mean age of 40.8 years (range, 20-60 years). There were 58 patients with compression fractures and 26 patients with burst fractures. Postoper-ative recovery rate, VAS score, operation time, bleeding volume and operation-related complications were analyzed retro-spectively. <br> Results:The average follow-up periods was 19.4 months (range, 11.5-36 months). Thirty-two patients underwent surgery within 72 h after injury in group A. Fifty-two patients underwent surgery after 72 h of injury in group B. There were no sig-nificant differences in postoperative recovery rate and VAS score between two groups (P>0.05). Compared with group B, patients in group A achieved a higher excellent rate of treatment (P<0.05), while the operation time was much longer and-bleeding volume was much more (P<0.01). Surgical intervention timing was not related to operation-related complications (P>0.05). <br> Conclusions:For spinal cord injury patients with thoracolumbar fractures, earlier surgical treatment can achieve better re-sults. However, there are some risk factors for early surgical treatment, such as bleeding, and longer operative time. There-fore, surgical intervention timing should be individual for thoracolumbar fracture.
