标题：椎间融合术治疗经椎间盘胸腰椎骨折-脱位疗效观察

      作者：韩运，窦庆寅，胡洪涌，钟威    （深圳市松岗人民医院骨科，广东 深圳 518105）

      卷次： 2017年28卷2期

      【摘要】 目的 探讨椎间融合术治疗经椎间盘胸腰椎骨折-脱位的临床疗效。方法 回顾性分析2013年3月至2016年3月间松岗人民医院骨科收治的62例经椎间盘胸腰椎骨折-脱位患者的临床资料，根据手术方式的不同分为经椎间孔椎体融合术组(A组，32例)和后外侧植骨融合术组(B组，30例)，比较两组患者手术时间、术中出血量，比较术前、术后1周和末次随访的骨折椎体高度、Cobb角变化；以及术前、术后3个月及末次随访脊髓神经功能评分，并于术后 3个月时评价临床疗效。结果 A组患者的术中出血量为(385.5±25.4) mL，明显少于B组的(460.7±12.8) mL，手术时间为(250.5±10.6) min，明显短于B组的(320.2±16.7) min，差异有统计学意义(P<0.05)；A组术后 1周的骨折椎体高度明显高于B组，Cobb角明显小于B组，差异有统计学意义(P<0.05)。两组患者末次随访的Cobb角、骨折椎体高度与术后1周比较无明显变化(P>0.05)，但组间仍有显著性差异(P<0.05)；术后3个月，两组的运动神经和感觉神经功能评分均较术前明显提高，并且A组显著高于B组，差异有统计学意义(P<0.05)。末次随访时，A组运动神经和感觉神经功能评分分别为(90.35±10.47)分、（225.45±10.54）分，均显著高于B组的(74.03±10.33)分、(201.54±11.32)分，差异有统计学意义(P<0.05)。A组的治疗总有效率为93.75%，显著高于B组的76.67%，差异有统计学意义(P<0.05)。结论 经椎间盘胸腰椎骨折-脱位患者行经椎间孔减压椎间融合术，能够有效纠正节段后凸角度，恢复椎体高度和神经功能，且并发症少，术后康复快，是治疗胸腰椎骨折-脱位的理想术式。
      【关键词】 经椎间孔椎体融合术；胸腰椎骨折-脱位；后外侧植骨术；疗效
      【中图分类号】 R683.2 【文献标识码】 A 【文章编号】 1003—6350（2017）02—0220—04

Therapeutic advantage of interbody fusion in the treatment of thoracolumbar fractures and dislocations.
HANYun, DOU Qing-yin, HU Hong-yong, ZHONG Wei. Department of Orthopedics, Songgang People's Hospital of ShenzhenCity, Shenzhen 518105, Guangdong, CHINA
【Abstract】 Objective To investigate the clinical effect of lumbar interbody fusion in the treatment of thoraco-lumbar fracture and dislocation. Methods A total of 62 cases of the intervertebral disc of thoracic and lumbar frac-ture-dislocation patients, who treated in Songgang People's Hospital of Shenzhen from March 2013 to March 2016, wereselected and divided into lumbar interbody fusion group (group A, 32 cases) and posterior posterolateral bone graft fu-sion group (group B, 30 cases) according to the different surgical methods. The the operation time, intraoperative bloodloss, the changes of fracture height of vertebral body and Cobb angle before the operation, 1 week after the operationand at the last follow-up were compared. Meanwhile, the spinal nerve function scores before the operation, 3 months af-ter the operation and at the last follow-up were compared, and clinical efficacy was evaluated at 3 months postoperative-ly. Results The amount of bleeding in the group A was (385.5±25.4) mL, which was significantly less than (460.7±12.8) mL in the group B (P<0.05); the the operation time was (250.5±10.6) min, which was significantly shorter than(320.2±16.7) min in the group B (P<0.05). The vertebral height of fracture 1 week after the operation in the group A wassignificantly higher than the group B (P<0.05), and the Cobb angle was significantly smaller than that of the group B (P<0.05). There was no significant change in the Cobb angle and vertebral height of the fracture of the two groups between1 week after the operation and at the last follow-up (P>0.05), but there were significant differences between the groups(P<0.05). After 3 months, the motor nerve and sensory nerve function scores of the two groups were significantly in-creased, and the group A were significantly higher than the B group (P<0.05). At the last follow-up, the motor and senso-ry nerve function score of the group A were (90.35±10.47) and (225.45±10.54), respectively, which were significantlyhigher than (74.03 ± 10.33) and (201.54 ± 11.32) in the group B (P<0.05). The total effective rate of the group A was93.75%, which was significantly higher than 76.67% in the group B (P<0.05). Conclusion Transforaminal lumbar in-terbody fusion can effectively correct the segmental kyphosis angle, and restore vertebral height and neural function re-covery in the treatment of thoracolumbar fracture and dislocation. This kind of therapy has fewer complications and fast-er postoperative recovery, which is an ideal surgical procedure for the treatment of thoracolumbar fracture-dislocation.
      【Key words】 Lumbar interbody fusion; Thoracolumbar fracture and dislocation; Posterior lateral bone grafting;Clinical effect·论 著·doi:10.3969/j.issn.1003-6350.2017.02.016