Ma Yi, Deng Shu-cai, Jia Zhan-hua, Hao Yong-hong
Department of Spinal Surgery, Tianjin Hospital, Tianjin 300211, China. Email:
Zhonghua Yi Xue Za Zhi. 2013 Jul 16;93(27):2112-6.
To compare the medium and long-term outcomes of lateral position one-stage plus anteroposterior versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures.
A total of 47 patients with thoracolumbar burst fractures were divided into 2 groups according to surgical approaches. Group A underwent lateral position one-stage plus anteroposterior approach while group B had posterior approach with subtotal corpectomy, decompression and reconstruction of spine. During a follow-up period of 36-68 months, their clinical and radiological outcomes were retrospectively evaluated. The perioperative volume of blood loss, operative duration, complications, pulmonary functions, Frankel scale and American Spinal Injury Association (ASIA) motor scores were recorded and analyzed. And the heights of anterior edge of vertebral body and Cobb angle were examined for radiological outcomes.
At the latest follow-up, all patients achieved solid fusion with significant neurological improvements. The perioperative volumes of blood loss were less, operative duration was shorter and postoperative pulmonary functions were better in the group B (P < 0.05). The ASIA motor score and radiological outcomes were not significantly different at all timepoints between two groups (P < 0.05). But the neurological functions of two groups improved by approximately 1.4 Frankel grade (group A) versus 1.41 (group B) at the final follow-up.
Lateral position one-stage plus anteroposterior and posterior approaches with subtotal corpectomy, decompression, and reconstruction of spine are adequate surgical treatments for thoracolumbar burst fractures. But the latter has the major advantages of less perioperative volume of blood loss, fewer complications, shorter operative duration and better pulmonary functions.
比较侧卧位一期前后联合入路与后路椎体次全切除、减压及脊柱重建治疗胸腰椎爆裂骨折的中长期疗效。
47例胸腰椎爆裂骨折患者按手术入路分为2组。A组采用侧卧位一期前后联合入路，B组采用后路椎体次全切除、减压及脊柱重建。在36 - 68个月的随访期内，对其临床和影像学结果进行回顾性评估。记录并分析围手术期失血量、手术时间、并发症、肺功能、Frankel分级和美国脊髓损伤协会（ASIA）运动评分。检查椎体前缘高度和Cobb角以评估影像学结果。
在最近一次随访时，所有患者均实现了牢固融合，神经功能有显著改善。B组围手术期失血量更少，手术时间更短，术后肺功能更好（P < 0.05）。两组在所有时间点的ASIA运动评分和影像学结果无显著差异（P < 0.05）。但在最终随访时，两组神经功能改善程度分别约为1.4个Frankel分级（A组）和1.41个Frankel分级（B组）。
侧卧位一期前后联合入路与后路椎体次全切除、减压及脊柱重建均是治疗胸腰椎爆裂骨折的合适手术方法。但后者具有围手术期失血量少（较少）、并发症少、手术时间短和肺功能更好的主要优势。
