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胸腰椎骨折合并神经损伤患者行前后路减压治疗的功能恢复、并发症及炎症因子变化的对比研究。

A Comparative Study on Functional Recovery, Complications, and Changes in Inflammatory Factors in Patients with Thoracolumbar Spinal Fracture Complicated with Nerve Injury Treated by Anterior and Posterior Decompression.

机构信息

Department of Neurosurgery, General Hospital of People's Liberation Army (PLA), Beijing, China (mainland).

Department of Obstetrics and Gynecology, Inner Mongolia Autonomous Region People's Hospital, Hohhot, Inner Mongolia, China (mainland).

出版信息

Med Sci Monit. 2019 Feb 12;25:1164-1168. doi: 10.12659/MSM.912332.

Abstract

BACKGROUND The aim of this study was to evaluate 2 methods to treat patients with thoracic lumbar spine fracture with merging spinal cord injury, including complications of surgery and the influence of inflammatory factors. MATERIAL AND METHODS Eighty patients were randomly divided into an anterior decompression group (study group) or a posterior decompression group (control group) to observe perioperative complications, evaluate preoperative and postoperative nerve function, and evaluate the 6-month injured vertebral height and Cobb angle of the vertebral bodies. The expression level of TGF-β₂ on day 1, day 7, day 15, and day 30 after treatment was detected by enzyme-linked immunosorbent assay (ELISA). RESULTS The nerve function sensation score, the height of the vertebral body, and the recovery of Cobb angle were better for the anterior decompression group than the posterior decompression group and the effect was significant (P<0.05). The complication rate for the posterior decompression group was lower than the anterior decompression group. The level of TGF-β₂ in the anterior decompression group was higher than in the posterior decompression group for the same times: after day 1, day 7, day 15, and day 30 after treatment (P<0.05). CONCLUSIONS Patients who had thoracic lumbar spine fracture with merging spinal cord injury and who had anterior fixation achieved a good fixation effect; their neurologic and vertebral injury recovery was better. However, this relatively complex and traumatic surgery must consider the clinical manifestations and fractures of the patients and select the appropriate surgical approach.

摘要

背景

本研究旨在评估 2 种治疗合并脊髓损伤的胸腰椎骨折患者的方法,包括手术并发症和炎症因子的影响。

材料和方法

将 80 例患者随机分为前路减压组(研究组)或后路减压组(对照组),观察围手术期并发症,评估术前和术后神经功能,并评估受伤椎体 6 个月的高度和椎体 Cobb 角。采用酶联免疫吸附试验(ELISA)检测治疗后第 1、7、15 和 30 天 TGF-β₂的表达水平。

结果

前路减压组的神经功能感觉评分、椎体高度和 Cobb 角恢复均优于后路减压组,差异有统计学意义(P<0.05)。后路减压组的并发症发生率低于前路减压组。同一时间点前路减压组 TGF-β₂水平均高于后路减压组:治疗后第 1、7、15 和 30 天(P<0.05)。

结论

合并脊髓损伤的胸腰椎骨折患者行前路固定可获得良好的固定效果,神经及椎体损伤恢复较好。但这种相对复杂和创伤性的手术必须考虑到患者的临床表现和骨折情况,选择合适的手术入路。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0e3a/6380160/97ae795a0ca1/medscimonit-25-1164-g001.jpg

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