■仍然没有标准的治疗胸腰椎爆裂骨折。随着最近的进步,后路仍然是治疗的主要方法之一。另一方面,而神经受损患者的椎管减压是治疗的重要目标,它的技术仍然存在争议。这项研究比较了直接椎板切除术减压与韧带移位/间接管减压对神经和影像学改善的影响。
■对符合我们纳入和排除标准的60例胸腰椎爆裂骨折患者进行了一项前瞻性双盲随机临床试验。他们被随机分为2个治疗组:(1)使用椎板切除术的直接减压和(2)使用韧带轴/牵引的间接减压。每位患者观察6个月,他们的神经和影像学数据是前瞻性收集的。统计分析采用学生t检验,弗里德曼测试,MannWhitney-U测试,威尔科克森排名测试,和单因素方差分析。
■在我们研究的60名患者中,每个治疗组的Frankel评分均有改善,但在任何给定时间,组间无差异.手术6个月后,两组局部矢状面后凸畸形均得到改善(间接组和直接组分别从32.2降至7.43,从29.93降至8.77,分别),以及前椎骨高度比(间接和直接组从57.73到70.7和62.17到66.27,分别)和后椎体高度比(间接和直接组的61.17至74.87和64至67.5,分别)。对于6个月后的组间比较,仅椎体后段高度比差异有统计学意义(P=0.040)。
■带韧带轴的后路入路已被证明是安全的,并且可能与使用广泛椎板切除术的直接减压技术具有相同的结果。
UNASSIGNED: There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial.This study compared the effects of direct laminectomy decompression against ligamentotaxis/
indirect canal decompression on neurological and radiographic improvements.
UNASSIGNED: A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct decompression using laminectomy and (2)
indirect decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance.
UNASSIGNED: Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the
indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the
indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the
indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio (P = 0.040).
UNASSIGNED: Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct decompression techniques using wide laminectomy.