半椎板切除脊髓前后减压治疗胸腰椎爆裂性骨折的临床疗效观察:腰椎爆裂骨折碎片挤压脊髓

　　[摘要] 目的 探讨半椎板切除脊髓前后减压治疗胸腰椎爆裂性骨折的临床疗效。 方法 选取我院2010年1月～2011年6月收治的胸腰椎爆裂性骨折患者43例作为观察组，采用半椎板切除脊髓前后减压和椎弓根钉系统复位内固定方法治疗，与采用传统后入路手术治疗的42例对照组胸腰椎爆裂性骨折患者进行比较。 结果 观察组术中出血量、手术时间、术后24 h伤口引流量、骨折愈合时间均明显少于对照组（P < 0.05）；观察组术后并发症发生率（2.3%）明显低于对照组（14.3%，P < 0.05）；观察组术后伤椎前缘高度和伤椎后缘高度均明显大于术前，术后Cobb角和椎管容积减少比较术前明显缩小，差异均有统计学意义（P < 0.05）。观察组术后Frankel分级评定情况明显好于对照组。 结论 采用半椎板切除脊髓前后减压治疗胸腰椎爆裂性骨折是一种安全有效的手术方法，手术操作简便且创伤小，术后并发症少且固定可靠，对患者脊柱结构造成的损伤较小，值得临床推广使用。
　　[关键词] 半椎板切除；脊髓前后减压；胸腰椎骨折
　　[中图分类号] R681.5 [文献标识码] A [文章编号] 1673-7210（2012）07（b）-0042-03
　　Clinical research on semi laminectomy spinal cord before and after decompression in the treatment of thoracolumbar burst fractures
　　TAN Shengfu WU Jianguo
　　Department of Orthopasdics, the People"s Hospital of Yishui County, Shandong Province, Yishui 276400, China
　　[Abstract] Objective To investigate the clinical efficacy of semi laminectomy spinal cord before and after decompression in the treatment of thoracolumbar burst fractures. Methods 43 cases of patients with thoracolumbar burst fractures in our hospital from January 2010 to June 2011were selected as the observation group, who were given the semi laminectomy spinal cord before and after decompression and pedicle screw system internal fixation methods treatment. 42 cases of patients with thoracolumbar burst fractures were selected as the control group, who were given the traditional approach operation treatment. The clinical efficacy of the two groups were compared. Results Amount of bleeding in operation, operative time, amount of postoperative 24 h wound drainage, fracture healing time of the observation group were significantly shorter than those of the control group (P < 0.05). The incidence of postoperative complications in the observation group (2.3%) was significantly lower than that of the control group (14.3%, P < 0.05). The front height and back height of fracture vertebra after operation were significantly greater than those of before operation in the observation group (P < 0.05). The Cobb angle and volume of vertebral canal reduction rate after operation were less than those of before operation significantly in the observation group (P < 0.05). Frankel grading of patients in the observation group was obviously better than that of the control group. Conclusion Application of semi laminectomy spinal cord before and after decompression in the treatment of thoracolumbar burst fractures is a safe and effective operation method. The operation is simple and has small trauma, which has less postoperative complications and reliable fixation. The operation has less damage to the spinal structure, which is worthy of clinical use.