中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2015年
8期
1278-1282
,共5页
于鑫%杨申%魏开斌%冀承波
于鑫%楊申%魏開斌%冀承波
우흠%양신%위개빈%기승파
脊柱骨折%后路减压钛网植骨内固定%脊柱前%中柱稳定性%适应证
脊柱骨摺%後路減壓鈦網植骨內固定%脊柱前%中柱穩定性%適應證
척주골절%후로감압태망식골내고정%척주전%중주은정성%괄응증
Spinal fractures%Posterior decompression and internal fixation through Titanium Rete bone-transplanting%Stability of anterior and middle columns%Indication
目的：研究经后路减压钛网植骨内固定手术方式治疗胸腰椎严重爆裂性骨折的临床疗效，探讨其在重建脊柱前、中柱稳定性中的适应证。方法选取泰安市中心医院骨科收治的94例胸腰椎严重爆裂性骨折患者，分为前路手术及后路手术两组，均给予完整12～48个月随访，对术前术后多项临床指标变化进行系统的统计学分析比较。结果后路手术组术中出血量为（893.31±134.15）ml，手术时间为（247.36±18.72）min，VAS疼痛评分后路手术组由术前5.78±1.27下降至术后2.41±0.73，术前、术后对肺功能的影响指标上，均明显优于前路手术组，与之比较均有统计学差异（P＜0.05）；后路手术组在术前及术后随访时椎体前、后缘高度比值及其脊柱矫正度和随访丢失率，后凸成角及其脊柱矫正率和随访丢失率，椎管容积，术前、术后的神经功能 ASIA 评分，与前路手术组相比较不具有统计学差异（P＞0.05）。结论治疗胸腰椎严重爆裂性骨折，经后路减压钛网植骨内固定的手术方式通过相对简洁直观的后方手术入路及操作达到了充分减压重建、牢靠固定的前路手术效果，而在术中出血量及手术用时，术后疼痛症状的发生及改善，术前术后肺功能的干预影响，并发症的出现方面则较前路手术有着明显的优越性。
目的：研究經後路減壓鈦網植骨內固定手術方式治療胸腰椎嚴重爆裂性骨摺的臨床療效，探討其在重建脊柱前、中柱穩定性中的適應證。方法選取泰安市中心醫院骨科收治的94例胸腰椎嚴重爆裂性骨摺患者，分為前路手術及後路手術兩組，均給予完整12～48箇月隨訪，對術前術後多項臨床指標變化進行繫統的統計學分析比較。結果後路手術組術中齣血量為（893.31±134.15）ml，手術時間為（247.36±18.72）min，VAS疼痛評分後路手術組由術前5.78±1.27下降至術後2.41±0.73，術前、術後對肺功能的影響指標上，均明顯優于前路手術組，與之比較均有統計學差異（P＜0.05）；後路手術組在術前及術後隨訪時椎體前、後緣高度比值及其脊柱矯正度和隨訪丟失率，後凸成角及其脊柱矯正率和隨訪丟失率，椎管容積，術前、術後的神經功能 ASIA 評分，與前路手術組相比較不具有統計學差異（P＞0.05）。結論治療胸腰椎嚴重爆裂性骨摺，經後路減壓鈦網植骨內固定的手術方式通過相對簡潔直觀的後方手術入路及操作達到瞭充分減壓重建、牢靠固定的前路手術效果，而在術中齣血量及手術用時，術後疼痛癥狀的髮生及改善，術前術後肺功能的榦預影響，併髮癥的齣現方麵則較前路手術有著明顯的優越性。
목적：연구경후로감압태망식골내고정수술방식치료흉요추엄중폭렬성골절적림상료효，탐토기재중건척주전、중주은정성중적괄응증。방법선취태안시중심의원골과수치적94례흉요추엄중폭렬성골절환자，분위전로수술급후로수술량조，균급여완정12～48개월수방，대술전술후다항림상지표변화진행계통적통계학분석비교。결과후로수술조술중출혈량위（893.31±134.15）ml，수술시간위（247.36±18.72）min，VAS동통평분후로수술조유술전5.78±1.27하강지술후2.41±0.73，술전、술후대폐공능적영향지표상，균명현우우전로수술조，여지비교균유통계학차이（P＜0.05）；후로수술조재술전급술후수방시추체전、후연고도비치급기척주교정도화수방주실솔，후철성각급기척주교정솔화수방주실솔，추관용적，술전、술후적신경공능 ASIA 평분，여전로수술조상비교불구유통계학차이（P＞0.05）。결론치료흉요추엄중폭렬성골절，경후로감압태망식골내고정적수술방식통과상대간길직관적후방수술입로급조작체도료충분감압중건、뢰고고정적전로수술효과，이재술중출혈량급수술용시，술후동통증상적발생급개선，술전술후폐공능적간예영향，병발증적출현방면칙교전로수술유착명현적우월성。
Objective To evaluate the clinic effect of the posterior decompression, bone graft and titanium rete internal fixation of the severe thoracolumbar spine burst fractures. To explore the indications to reconstruct the stability of the anterior and middle columns. Methods 94 cases of severe thoracolumbar spine burst fractures treated in Taian Central Hospital were included in this study, which were divided into 2 group of anterior approach group and posterior approach group. Lots of observation indexes of preoperative and postoperative with 12-48 months followed up were statistics analyzed systematically. Results For posterior approaches group, the intraoperative blood loss was (893.31±134.15) ml, and the operation time was (247.36±18.72)min, and the VAS score was declined from 5.78±1.27 to 2.41±0.73. There was significant difference between two groups (P<0.05) in intraoperative blood loss, operation time, VAS score and lung function, and there was no significant difference between two groups (P>0.05) in the height ratio of vertebra anterior border and posterior border, the spinal correction, follow-up loss rate, kyphosis angle, vertebral canal volume, neural function grade of ASIA. Conclusion To treat of severe thoracolumbar spine burst fractures, the posterior decompression, bone graft and titanium rete internal fixation has the same effect in decompression, reconstruction and fixation with the anterior approaches while the operating is much considered. Otherwise, the posterior approach surgery has advance in intraoperative blood loss, operation time, VAS score and lung function.
