Danisa O A, Shaffrey C I, Jane J A, Whitehill R, Wang G J, Szabo T A, Hansen C A, Shaffrey M E, Chan D P
Department of Orthopedics, University of Virginia Health Sciences Center, Charlottesville, USA.
J Neurosurg. 1995 Dec;83(6):977-83. doi: 10.3171/jns.1995.83.6.0977.
The authors retrospectively studied 49 nonparaplegic patients who sustained acute unstable thoracolumbar burst fractures. All patients underwent surgical treatment and were followed for an average of 27 months. All but one patient achieved solid radiographic fusion. Three treatment groups were studied: the first group of 16 patients underwent anterior decompression and fusion with instrumentation; the second group of 27 patients underwent posterior decompression and fusion; and the third group of six patients had combined anterior-posterior surgery. Prior to surgical intervention, these groups were compared and found to be similar in age, gender, level of injury, percentage of canal compromise, neurological function, and kyphosis. Patients treated with posterior surgery had a statistically significant diminution in operative time and blood loss and number of units transfused. There were no significant intergroup differences when considering postoperative kyphotic correction, neurological function, pain assessment, or the ability to return to work. Posterior surgery was found to be as effective as anterior or anterior-posterior surgery when treating unstable thoracolumbar burst fractures. Posterior surgery, however, takes the least time, causes the least blood loss, and is the least expensive of the three procedures.
作者回顾性研究了49例发生急性不稳定胸腰椎爆裂骨折的非截瘫患者。所有患者均接受了手术治疗，平均随访27个月。除1例患者外，所有患者均获得了坚实的影像学融合。研究了三个治疗组：第一组16例患者接受前路减压、融合及内固定术；第二组27例患者接受后路减压及融合术；第三组6例患者接受前后联合手术。在手术干预前，对这些组进行比较，发现它们在年龄、性别、损伤节段、椎管狭窄百分比、神经功能和后凸畸形方面相似。接受后路手术的患者在手术时间、失血量和输血量方面有统计学意义的减少。在考虑术后后凸畸形矫正、神经功能、疼痛评估或恢复工作能力时，组间无显著差异。发现后路手术在治疗不稳定胸腰椎爆裂骨折时与前路或前后联合手术一样有效。然而，后路手术耗时最少，失血量最少，且是三种手术中费用最低的。
