不同手术方法治疗胸腰段骨折脱位并截瘫临床疗效比较.docVIP

不同手术方法治疗胸腰段骨折脱位并截瘫临床疗效比较[摘要] 目的：分析比较不同手术方法治疗胸腰段骨折脱位并截瘫的疗效差异及内固定装置的利弊。方法：对1996～2009年240例急性胸腰段骨折脱位伴截瘫所施行的前路Armstrong钢板、Kaneta装置和后路Harrington棒、Luque棒的患者的临床资料进行回顾分析。结果：前、后路手术神经功能的恢复率分别为88％和76% (P0.05)。结论：胸腰段骨折手术途径及固定方法宜根据脊柱生物力学的破坏程度、脊髓受压的部位进行选择，手术时机最好在伤后3~7 d。 [关键词] 胸腰段骨折；脱位；截瘫；内固定 [中图分类号] R683.2 [文献标识码]A [文章编号]1674-4721（2010）10（c）-009－０3 Thoracolumbar fracture and dislocation: a retrospectively comparison of various surgical outcome ZHANG Daofeng, FAN Li, ZHANG Zhishan (Department of Orthopaedic Trauma, the People′s Hospital of Jimo, Shandong Province, Jimo266200, China) [Abstract] Obejective: To compare the outcome of different surgeries in the treatment of thoracolumbar fracture and dislocation associated with paraplegia. Methods: From 1996 to 2009, clinical data of 240 patients with thoracolumbar fracture and dislocation associated with paraplegia were studied retrospectively. Sixty-eight patients were managed with anterior decompression, Armstrong plate or Kaneta device fixation. One hundred and seventy-two cases were operated with posterior approach and Harringtons rod, Luque rod, Dick screw or RF operation. Results: All patients were followed up for an average of 1.5 years. The relief of spinal canal compression and neurological deficit improved for anterior approach surgery were superior to posterior′s. The rate of neurological funtional recovery was 88% and 76% respectively (P0.05). Conclusion: These observations suggested that the surgical approachs and fixation must depend on the canal compressive site as well as in accord with the principle of spinal biomechanics. [Key words] Thoracolumbar fracture; Dislocation; Paraplegia; Internal fixation 胸腰椎骨折是脊柱外科的常见病、多发病，但目前对于其治疗无论是在手术方法还是在内固定物的选择方面均尚有争议。本文将1996～2009年于本院接受手术治疗的急性胸腰段骨折并截瘫患者240例予以分析比较，对各种手术方法及内固定物的利弊与疗效总结如下： 1 资料与方法 1.1 一般资料 240例中，男性203例，女性37例，年龄18～59岁，平均（35.0±5.8）岁。损伤部位：T11 11例，T12 43例，L1 140例，L2 46例。受伤至手术时间4～15 d，平均（6.5±3.6） d。根据Denis分类[1]，骨折类型：爆裂骨折168例 (70％)，骨折脱位72例(30