间接减压与开放减压治疗无神经损伤的胸腰椎爆裂骨折对椎管减压效果的对比研究

[Comparative study on indirect decompression versus open decompression to vertebral canal in treating thoracolumbar burst fractures without neurologic deficit].

作者信息

Yang Jinhua, Huang Kai, Yang Zonghua, Wang Xiaolin, Xiao Jianru

机构信息

Department of Orthopaedics, Changshu Second People's Hospital, Changshu Jiangsu, 215500, PR China.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2010 Jan;24(1):32-6.

DOI:

PMID:20135967

Abstract

OBJECTIVE

To compare the clinical effects of indirect decompression versus open decompression to vertebral canal in treatment of thoracolumbar burst fractures without neurologic deficit.

METHODS

From April 2004 to June 2008, 52 cases of thoracolumbar burst fracture without neurologic deficit underwent posterior exposition, reduction and fixation with Atlas Fixator (AF) instrumentation. There were 34 males and 18 females with an average age of 43.1 years (range, 31-63 years). The affected locations were T11 in 5 cases, T12 in 24 cases, L1 in 16 cases, and L2 in 7 cases. The time from injury to operation was 3-8 days (4.4 days on average). All cases were divided into indirect decompression group (group A) and open decompression group (group B). There were no statistically significant differences (P > 0.05) in sex, age, affect site, and disease course between two groups. The operative time, blood loss were recorded. Preoperatively, immediately postoperatively and at last follow-up, the height of the fracture vertebra and the Cobb angle were obtained from X-ray pictures and were statistically analysed. Radiographic parameters on computed tomography (CT) pictures were used to get the encroachment rate of vertebral canal.

RESULTS

The operative time was (87.3 +/-7.9) minutes and (125.3 +/- 13.6) minutes, and the blood loss was (273.7 +/- 23.4) mL and (512.6 +/- 37.7) mL in groups A and B, respectively; showing statistically significant differences (P < 0.05). The average follow-up time was 17.4 months (range, 11-31 months) in group A and 19.9 months (range, 12-33 months) in group B. All wounds achieved primary healing postoperatively without deaths and spinal cord injuries. Postoperative complications in group B included 3 cases of screws loosening, 1 case of screw breakage, and 3 cases of low back pain, and were given symptomatic management. There were no statistically significant differences (P > 0.05) in the height of the fracture vertebra, the Cobb angle and the encroachment rate of vertebral canal preoperatively or postoperatively between two groups. There were statistically significant differences (P < 0.05) in the above three parameters between preoperation and postoperation in two groups, but there were no statistically significant differences (P > 0.05) in the spinal correction between two groups. The losing-rate of spinal correction of the height of the fracture vertebra and the Cobb angle of group A was lower than group B, showing statistically significant differences (P < 0.05).

CONCLUSION

The short-term results of two decompression styles in treatment of thoracolumbar burst fractures without neurologic deficit were satisfactory, but indirect decompression has more merits than open decompression: shorter operative time, less blood loss, lower losing-rate of spinal correction, and better stabilization of vertebral column.

摘要

目的

比较间接减压与椎管开放减压治疗无神经损伤的胸腰椎爆裂骨折的临床效果。

方法

2004年4月至2008年6月，52例无神经损伤的胸腰椎爆裂骨折患者接受后路显露、复位并使用寰枢椎固定器（AF）器械固定。其中男性34例，女性18例，平均年龄43.1岁（范围31 - 63岁）。损伤部位：T11 5例，T12 24例，L1 16例，L2 7例。受伤至手术时间为3 - 8天（平均4.4天）。所有病例分为间接减压组（A组）和开放减压组（B组）。两组在性别、年龄、损伤部位及病程方面差异无统计学意义（P > 0.05）。记录手术时间、失血量。术前、术后即刻及末次随访时，从X线片获取骨折椎体高度及Cobb角并进行统计学分析。利用计算机断层扫描（CT）图像上的影像学参数计算椎管侵占率。

结果

A组和B组手术时间分别为（87.3±7.9）分钟和（125.3±13.6）分钟，失血量分别为（273.7±23.4）mL和（512.6±37.7）mL；差异有统计学意义（P < 0.05）。A组平均随访时间为17.4个月（范围11 - 31个月），B组为19.9个月（范围12 - 33个月）。所有伤口术后均一期愈合，无死亡及脊髓损伤病例。B组术后并发症包括螺钉松动3例、螺钉断裂1例、腰痛3例，均给予对症处理。两组术前及术后骨折椎体高度、Cobb角及椎管侵占率差异无统计学意义（P > 0.05）。两组术前与术后上述三项参数差异有统计学意义（P < 0.05），但两组间脊柱矫正效果差异无统计学意义（P > 0.05）。A组骨折椎体高度及Cobb角的脊柱矫正丢失率低于B组，差异有统计学意义（P < 0.05）。