摘要
目的 探讨经后路保留后柱稳定结构减压治疗腰椎爆裂骨折伴神经损伤的效果及其对椎体和神经功能指标的影响.方法 选取2005年2月至2014年7月间我院收治的52例腰椎爆裂性骨折伴神经损伤患者为研究对象,依据选择的手术方式是否保留后柱稳定性结构将患者分为保留组（28例）和不保留组（24例）.分别比较两组患者的手术疗效,椎体和神经功能测量指标的改变.结果 术后3个月、6个月和12个月,两组患者的矢状径、伤椎高度、椎体前体高度、椎间隙高度均明显升高,Cobb角、受压面积和矢状面位移率显著降低（F组内分别为10.492、8.858、7.432、16.311、19.491、10.329、21.587,P均〈0.05）,而且保留组患者Cobb角、椎间隙高度、受压面积和矢状径的改善幅度均明显优于不保留组（P均〈0.05）;但是两组间融合率、术中出血量、术后并发症发生率、Denis疼痛评分、伤椎高度、椎体前体高度和矢状面位移率比较差异均无统计学意义（P均〉0.05）;术后两组患者的ASIA分级逐步好转,保留组在术后6个月即出现神经脊髓功能的恢复,而不保留组则在术后12个月才呈现,并且,术后12个月保留组E级比率（64.29%）显著高于不保留组（45.83%）（F交互=12.758,P〈0.001）;保留组患者术后3个月神经元特异性烯醇化酶（NSE）、S100B蛋白和髓鞘碱性蛋白（MBP）均明显低于不保留组（P均〈0.05）;保留组术后6个月S100B和MBP的改善程度优于不保留组（P均〈0.05）,到术后12个月,仅MBP的降低幅度优于不保留组（P〈0.05）.结论 经后路保留后柱稳定结构减压对腰椎爆裂骨折伴神经损伤患者具有良好的临床疗效,且能显著改善患者的椎体形态和神经功能.
Objective To explore the effect of posterior column stability and decompression on the treatment of lumbar burst fracture with nerve injury and its effect on vertebral body and neurological function.Methods Fifty-two cases patients of lumbar burst fracture with nerve injury from February 2005 to July 2014 in Affiliated Hospital of Youjiang Medical College For Nationalities were selected as the research objects and divided into retention group（28 cases） and non-retention group（24 cases） according to the choice of operation method.The surgical clinical efficacy,the changes of the vertebral body and nerve function were compared between two groups.Results At 3 months,6 months and 12 months after operation,the fusion rate,sagittal diameter and the height of the injured vertebral body,pre-vertebral body,and intervertebral space were all significantly increased,while the Cobb angle,the pressure area and the sagittal displacement rate were markedly decreased（F of inner grouP=10.492,8.858,7.432,16.311,19.491,10.329,21.587;P〈0.05）,and the improvement range of Cobb angle,intervertebral space,the pressure area and sagittal displacement rate of retention group were significant better than non-retention group.There was no significant difference on the fusion rate,the volume of bleeding,the incidence of postoperative complications,Denis pain score,the height of injured vertebral body,pre-vertebral body,and sagittal displacement between the two groups（P〉0.05）.After operation,the ASIA grade gradually improved,neurological function of the retention group recovered at 6 months after surgery,while non-retention group presented this effect at 12 months after surgery,moreover,at 12 months after operation,the proportion of E grade in retention group was 64.29%,higher than that of non-retention group（45.83%,F=12.758,P〈0.001）.The levels of neuron-specific enolase（NSE）,S100B protein and myelin basic protein（MBP） in retention group were significantly lower than those of the non-retention group at 3 months after surgery（P〈0.05）.The improvement of S100B and MBP in the reservation group at 6 months after surgery were better than those of non-retention group,while at 12 months after surgery,only the improvement of MBP in retention group showed the better effects than non-retention group.Conclusion Posterior column stability and decompression show a high clinical efficacy on the treatment of lumbar burst fracture with nerve injury and it can significantly improve the vertebral body and neurological function.
作者
班华登
罗群强
莫雄革
阮文武
Ban Huadeng Luo Qunqiang Mo Xiongge Ruan Wenwu(Hand and Foot Surgery Department ,Affiliated Hospital of Youjiang Medical College For Nationalities ,Baise 533000, Chin)
出处
《中国综合临床》
2017年第4期312-316,共5页
Clinical Medicine of China
基金
2014年广西自然科学基金青年基金项目（2014jjBA40145）
关键词
腰椎爆裂骨折
神经损伤
椎体
后柱稳定结构减压法
Lumbar burst fracture
Nerve injury
Vertebral body
Posterior column stability and decompression
