中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
32期
8-11
,共4页
脊柱骨折%内固定器%减压术,外科%神经功能损伤
脊柱骨摺%內固定器%減壓術,外科%神經功能損傷
척주골절%내고정기%감압술,외과%신경공능손상
Spinal fractures%Internal fixators%Deampression,surgical%Heurologic deficits
目的 评价后路减压短节段椎弓根内固定治疗不同时段胸腰椎骨折伴神经功能不全损伤的临床疗效.方法 将79例行后路减压短节段椎弓根内固定治疗的胸腰椎骨折伴神经功能不全损伤患者按受伤与手术时间间隔不同分为≤24h组(41例)和＞24h组(38例),通过影像学及神经功能恢复情况来评估疗效.结果 术后住院期间均行X线复查,术后10～14 d出院,切口均一期愈合.79例均获得随访,平均23.5(15 ～32)个月.术中未出现手术源性神经损伤及术后感染,术后无脊髓损伤加重现象,未发生内置物断裂、折弯和螺钉松动现象.两组术后3d和末次随访伤椎压缩率、后凸Cobb角均较术前明显改善[≤24 h组:(7.9±4.2)％、(8.5±5.0)％比(40.8±8.4)％和(3.9±2.5)°、(4.2±2.6)°比(28.1±13.1)°;＞24h组:(8.8±4.8)％、(9.2±4.8)％比(41.7±7.6)％和(5.3±2.6)°、(5.7±2.7)°比(27.6±12.1)°],差异有统计学意义(P＜0.05),但两组间比较差异无统计学意义(P＞0.05).两组术后3d椎管狭窄率均较术前明显改善[≤24h组:(5.3±1.5)％比(41.4±6.1)％;＞24h组:(6.8±1.1)％比(40.5±5.4)％],差异有统计学意义(P＜0.05),且≤24h组明显优于＞24 h组,差异有统计学意义(P＜0.05).两组末次随访时,脊髓功能大部分有ASIA分级1～2级的恢复,≤24 h组平均改善1.4级,＞24 h组平均改善1.2级.结论 及时行后路减压短节段椎弓根内固定治疗胸腰椎骨折伴神经功能不全损伤能很好地重建脊柱的稳定性,有利于神经功能的恢复.
目的 評價後路減壓短節段椎弓根內固定治療不同時段胸腰椎骨摺伴神經功能不全損傷的臨床療效.方法 將79例行後路減壓短節段椎弓根內固定治療的胸腰椎骨摺伴神經功能不全損傷患者按受傷與手術時間間隔不同分為≤24h組(41例)和＞24h組(38例),通過影像學及神經功能恢複情況來評估療效.結果 術後住院期間均行X線複查,術後10～14 d齣院,切口均一期愈閤.79例均穫得隨訪,平均23.5(15 ～32)箇月.術中未齣現手術源性神經損傷及術後感染,術後無脊髓損傷加重現象,未髮生內置物斷裂、摺彎和螺釘鬆動現象.兩組術後3d和末次隨訪傷椎壓縮率、後凸Cobb角均較術前明顯改善[≤24 h組:(7.9±4.2)％、(8.5±5.0)％比(40.8±8.4)％和(3.9±2.5)°、(4.2±2.6)°比(28.1±13.1)°;＞24h組:(8.8±4.8)％、(9.2±4.8)％比(41.7±7.6)％和(5.3±2.6)°、(5.7±2.7)°比(27.6±12.1)°],差異有統計學意義(P＜0.05),但兩組間比較差異無統計學意義(P＞0.05).兩組術後3d椎管狹窄率均較術前明顯改善[≤24h組:(5.3±1.5)％比(41.4±6.1)％;＞24h組:(6.8±1.1)％比(40.5±5.4)％],差異有統計學意義(P＜0.05),且≤24h組明顯優于＞24 h組,差異有統計學意義(P＜0.05).兩組末次隨訪時,脊髓功能大部分有ASIA分級1～2級的恢複,≤24 h組平均改善1.4級,＞24 h組平均改善1.2級.結論 及時行後路減壓短節段椎弓根內固定治療胸腰椎骨摺伴神經功能不全損傷能很好地重建脊柱的穩定性,有利于神經功能的恢複.
목적 평개후로감압단절단추궁근내고정치료불동시단흉요추골절반신경공능불전손상적림상료효.방법 장79례행후로감압단절단추궁근내고정치료적흉요추골절반신경공능불전손상환자안수상여수술시간간격불동분위≤24h조(41례)화＞24h조(38례),통과영상학급신경공능회복정황래평고료효.결과 술후주원기간균행X선복사,술후10～14 d출원,절구균일기유합.79례균획득수방,평균23.5(15 ～32)개월.술중미출현수술원성신경손상급술후감염,술후무척수손상가중현상,미발생내치물단렬、절만화라정송동현상.량조술후3d화말차수방상추압축솔、후철Cobb각균교술전명현개선[≤24 h조:(7.9±4.2)％、(8.5±5.0)％비(40.8±8.4)％화(3.9±2.5)°、(4.2±2.6)°비(28.1±13.1)°;＞24h조:(8.8±4.8)％、(9.2±4.8)％비(41.7±7.6)％화(5.3±2.6)°、(5.7±2.7)°비(27.6±12.1)°],차이유통계학의의(P＜0.05),단량조간비교차이무통계학의의(P＞0.05).량조술후3d추관협착솔균교술전명현개선[≤24h조:(5.3±1.5)％비(41.4±6.1)％;＞24h조:(6.8±1.1)％비(40.5±5.4)％],차이유통계학의의(P＜0.05),차≤24h조명현우우＞24 h조,차이유통계학의의(P＜0.05).량조말차수방시,척수공능대부분유ASIA분급1～2급적회복,≤24 h조평균개선1.4급,＞24 h조평균개선1.2급.결론 급시행후로감압단절단추궁근내고정치료흉요추골절반신경공능불전손상능흔호지중건척주적은정성,유리우신경공능적회복.
Objective To evaluate the chnical effect of posterior decompression and shortsegment pedicle instrumentation treating for thoracolumbar fracture with neurologic deficits in different time intervals.Methods Seventy-nine cases of thoracolumbar fracture with neurologic deficits were treated with shortsegment pedicle instrumentation combined with decompression according to the injury and surgery patients with injury of different time interval were divided into ≤24 h group (41 cases) and ＞ 24 h group (38 cases),the curative effect was evaluated by imaging and nerve function recovery.Results Postoperative hospital stay were performed X-ray check,10-14 d after hospital discharge,were primary healing of incision.A total of 79 patients with thoracolumbar fracture combined with neurologic deficits were followed up for 23.5 (15-32) months averagely.Did not appear in the source sex procedure for postoperative infection,nerve injury and postoperative spinal cord injury aggravated phenomenon,not implants rupture,bending and screw loose phenomenon.There was significant difference at 3 d postoperative and the last follow-up in the rate of vertebral compression,cobb' s angle and spinal canal stenosis rate in two groups [≤ 24 h group:(7.9 ± 4.2)％,(8.5 ± 5.0)％ vs.(40.8 ± 8.4)％ and (3.9 ± 2.5)°,(4.2 ± 2.6)° vs.(28.1 ± 13.1)° ; ＞ 24 h group:(8.8 ± 4.8)％,(9.2 ± 4.8)％ vs.(41.7 ± 7.6)％ and (5.3 ± 2.6)°,(5.7 ± 2.7)° vs.(27.6 ± 12.1)°] (P ＜ 0.05),but there was no statistically significant difference between two groups (P ＞ 0.05).The stenosis rate in two groups at 3 d postoperative was obviously better than preoperative[≤24 h group:(5.3 ± 1.5)％ vs.(41.4 ± 6.1)％; ＞ 24 h group:(6.8 ± 1.1)％ vs.(40.5 ± 5.4)％] (P ＜ 0.05),and ≤ 24 h group was superior to ＞ 24 h group,there was significant difference (P ＜ 0.05).At the last follow-up,the neurological function with ASIA grade 1-2 level recovery,≤24 h group mean improved 1.4 level,and ＞ 24 h group mean improved 1.2 level.Conclusion The opertion of pedicle instrumentation combined with decompression with nerve function damage can rebuild spinal stability,favorable neural functional recovery.
