胸腰段脊柱脊髓损伤前路手术治疗.DOCVIP

临床医学论文-胸腰段脊柱脊髓损伤前路手术治疗 ???????????? 作者：陈学明 关骅 郭险峰 姚爱民 王德成 于振山 朱旭 刘亮 【摘要】 目的? 探讨胸腰段脊柱脊髓损伤前路手术适应证、手术时机。 方法? 回顾性分析74例胸腰段脊柱脊髓损伤前路手术患者。随访时间7个月～11年6个月，平均4年2个月。 结果? 完全性神经损伤患者随访时下肢运动评分平均提高0.86分，6例（27.2%）患者大小便功能好转;不完全性神经损伤患者随访时下肢运动评分平均提高13.00分，31例（59.6%）患者大小便功能好转，8例（15.4%）患者大小便功能恢复正常。52例不完全性神经损伤患者分为3组:Ⅰ组≤15d、15dⅡ组3个月、Ⅲ组3个月。Ⅰ、Ⅱ组患者大小便功能改善明显好于Ⅲ组;Ⅰ、Ⅱ组患者术后改善的ASIA评分明显好于Ⅲ组。 结论? 正确选择适应证，胸腰椎骨折前路手术有较好的疗效。早期减压及早期康复，有助于下肢运动及大小便功能改善。 ??? 关键词? 胸腰椎脊柱 骨折 前路减压 ??? Anterior operative management for thoracolumbar fractures with spinal cord injuries ??? 【Abstract】 Objective To explore the indications for anterior operative management in patients with thora-columbar spine fractures with spinal cord injuries（SCI）and timing of surgery.Methods 74cases of thoracolumbar spine fractures and SCI operated upon with anterior operative management were analyzed retrospectively.The average duration of follow-up was4years and2months（range from7months to11years and6months）.Results During the last follow-up，the improvement of the ASIA motor score in patients with complete SCIwas0.86，6of22patients demonstrated partial return of automatic bowl and bladder function.The improvement of the ASIA motor score in pa-tients with incomplete SCI was13.00，31of52patients demonstrated partial recovery of automatic bowl and bladder function，8（15.4%）of52patients demonstrated complete return of automatic bowl and bladder function.52patients with incomplete SCI were divided into3groups according to the interval from injury to surgery:GroupⅠ（within15days），groupⅡ（range，from15days to3months），groupⅢ（more than3months）.Patients in groupⅠ，Ⅱdemon-strated better return of automatic bowl and bladder function than those in groupⅢ，also patients in groupⅠ，Ⅱhad a higher average motor scores improvement than those in groupⅢ.Conclusion There are good results in patients with thoracolumbar spine fractures with SCI after anterior decompression.The patients treated with early decompression and early rehabilitation have a higher ASIA motor scores i