无神经损伤的胸腰椎爆裂性骨...椎管侵占患者术式选择及疗效_孙凌.pdf

脊柱脊髓损伤无神经损伤的胸腰椎爆裂性骨折伴椎管侵占患者术式选择及疗效孙凌，谢希惠，曹瑞，王伟泰州市姜堰中医院骨伤科，江苏泰州225500【通信作者】谢希惠，E-mail:770890909 qqcom摘要目的探讨无神经损伤的胸腰椎爆裂性骨折伴椎管侵占患者术式选择及其疗效。方法回顾性分析 2015 年 4 月2019 年 4 月泰州市姜堰中医院收治无神经损伤的胸腰椎爆裂性骨折伴椎管侵占患者94 例，男性64 例，女性30 例;年龄1859 岁，平均388 岁，根据后路椎弓根内固定术后是否合并后路椎板切除减压术分为减压组(41 例)和非减压组(53 例)。减压组男性 29 例，女性 12 例;年龄 1856 岁，平均 384岁;高处坠落伤 20 例，道路交通伤 10 例，压砸伤 9 例，其他原因 2 例。非减压组，男性 35 例，女性18 例;年龄1959 岁，平均 393 岁;高处坠落伤 26 例，道路交通伤 15 例，压砸伤 10 例，其他原因 2 例。比较两组患者的疗效、手术时长、术中出血量、术后引流量、术后卧床时间、住院时长，术前，术后 1、6、12 个月 Oswestry 功能障碍指数(Oswestry disability index，ODI)，术前，术后 3d、12 个月伤椎前、后缘高度、椎管容积比、Cobb 角、美国脊髓损伤委员会(American spinal injury association，ASIA)运动功能评分(ASIA motor score，AMS)、视觉模拟评分(visual analogue scale，VAS)、肺部感染、切口感染、椎弓根钉松动、伤椎“空壳”情况。结果减压组手术时长、术中出血量、术后引流量多于非减压组(1186228)min vs(844175)min、(4795573)mL vs(2314247)mL、(2199253)mL vs(1063175)mL，P005，术后 12 个月 ODI 小于非减压组(4211)分 vs(5113)分，P005。减压组术前较术后 3d 伤椎前缘高度低(177034)cm vs(292028)cm、后缘高度低(168016)cm vs(208021)cm、椎管容积比小(784)%vs(893)%、Cobb 角大(2089346)vs(736186)，术前、术后 3d 较术后 12 个月 AMS 低(44794)分 vs(513102)分、(44794)分 vs(82580)分、(513102)分 vs(82580)分、VAS 高(7813)分 vs(4911)分、(7813)分 vs(2207)分、(4911)分 vs(2207)分，差异均有统计学意义(P005);非减压组术前较术后 3d 伤椎前缘高度低(181032)cm vs(293025)cm、后缘高度低(169015)cm vs(215017)cm、椎管容积比小(794)%vs(884)%、Cobb 角大(2126207)vs(793164)、术前、术后 3d较术后 12 个月 AMS 低(43896)分 vs(52998)分、(43896)分 vs(849102)分、(52998)分 vs(849102)分、VAS 高(7711)分 vs(5208)分、(7711)分 vs(2106)分、(5208)分 vs(2106)分，差异均有统计学意义(P005)。两组患者组间疗效、术后卧床时间、住院时长，术前、术后 1、6 个月 ODI、术前，术后 3d、12 个月伤椎前缘高度、后缘高度、椎管容积比、AMS、VAS、肺部感染、切口感染、椎弓根钉松动、伤椎“空壳”比较差异均无统计学意义(P005)。结论无神经损伤的胸腰椎爆裂性骨折伴椎管侵占患者可根据后路椎弓根内固定术后伤椎后缘高度、Cobb 角、椎管容积的变化程度、椎管占位骨块回纳情况决定是否附加减压术，附加与不附加后路椎板切除减压术的路椎弓根内固定术均具有较好临床疗效。【关键词】胸腰椎爆裂性骨折;椎管侵占;神经损伤;手术方式;疗效【中图分类号】6873【文献标识码】A【DOI】103969/jissn10094237202302006Surgical options and outcomes for patients with thoracolumbar burst fractures without nerveinjury but spinal canal invasionSun Ling，Xie Xihui，Cao ui，Wang WeiDepartment of Orthopedics，Jiangyan Hospital of Traditional Chinese Medicine，Taizhou，Jiangsu225500，China【Abstract】ObjectiveTo explore the surgical options and outcomes in patients with thoracolumbar burstfractures without nerve injury but spinal canal invasionMethodsA retrospective analysis was conducted on theclinical data of 94 patients with thoracolumbar burst fractures and spinal canal invasion but without nerve injury，who111创伤外科杂志 2023 年第 25 卷第 2 期J Trauma Surg，2023，Vol25，No2were admitted to our hospital from Apr 2015 to Apr 2019 There were 64 males and 30 females，aged 18-59 years，mean 38 8 years According to whether posterior laminectomy and decompression was combinedly performedfollowing posterior pedicle screw fixation，patients were divided into decompression group(n=41)and non-decom-pression group(n=53)Among the decompression group，there were 29 males and 12 females，aged 18-56(mean384)years，with 20 cases of fall injuries，10 traffic accident injuries，9 crush injuries and 2 others As for the non-decompression group，there were 35 males and 18 females，aged 19-59(mean 393)years，with 26 fall injuries，15traffic accident injuries，10 crush injuries and 2 others The outcomes，operation time，intraoperative blood loss，post-operative drainage volume，postoperative bed rest time，hospital stay and Oswestry dysfunction index(ODI)before，1，6 and 12 months after surgery were compared between two groups Other variables like height of the anterior andposterior edge of the injured vertebrae，spinal canal volume ratio，Cobb angle，American Spinal Injury Associationmotor score(AMS)，visual analogue scale(VAS)score，pulmonary infection，incision infection，pedicle screw loose-ning and empty shell of the injured vertebrae were assessed before and 3 days as well as 12 months after surgeryesultsCompared with non-decompression group，the decompression group showed a longer operation duration(min，1186228 vs 844175)，more intraoperative blood loss(mL，4795573 vs 2314247)and postopera-tive drainage(mL，2199253 vs 1063175，P005);the ODI at 12 months after operation was smaller(4211 vs 5113，P005)In decompression group，compared with before surgery，the height of anterior edge(cm，177034 vs 292028)，posterior edge(cm，168016 vs 208021)，volume ratio of spinal canal(78%4%vs 89%3%)and Cobb angle(2089346 vs 736186)were largely improved at 3 days after surgery Atthe three time points of before surgery，postoperative 3 d and postoperative 12 months，AMS(44794，513102，82580)and VAS(7813，4911，2207)revealed statistically significant difference between each timepoint(all P005)In the non-decompression group，similar trend was observed Compared with before surgery，theanterior edge height(cm，181032 vs 293025)，posterior edge height(cm，169015 vs 215017)，spinalcanal volume ratio(79%4%vs 88%4%)，Cobb angle(2126207 vs 793164)were largely improvedat 3d after surgery AMS(43896，52998，849102)and VAS(7711，5208，2106)also revealedsignificant difference between each of the three time points of before surgery，postoperative 3d and postoperative 12months(all P005)Comparison between the decompression and non-decompression gr