脊柱骨折伴截瘫急诊手术与择期手术临床疗效对比研究

Comparative Study on the Clinical Efficacy of Emergency Operation and Elective Operation for Spinal Fracture with Paraplegia

摘要: 目的：比较脊柱骨折伴截瘫急诊手术与择期手术的临床疗效。方法：回顾性分析2017年1月至2020年12月在我院接受手术治疗并获得术后随访的118例脊柱骨折伴截瘫患者，根据患者的主观意愿及病情实际，分为急诊手术组(伤后6 h内手术，52例)和择期手术组(伤后4~7 d内手术，66例)。比较两组手术时间、术中出血量、术后引流量、手术相关并发症发生情况，术前、术后5 d及随访12个月时Cobb角、伤椎体前缘高度丢失、椎管占位、美国脊髓损伤学会评分(ASIA评分)、昆明步行分级(KLS)评分。结果：两组手术时间比较，差异无统计学意义(P > 0.05)；择期手术组术中出血量、术后引流量均少于急诊手术组，差异均有统计学意义(P < 0.05)；急诊手术组手术相关并发症发生率为9.62%，低于择期手术组的24.24%，差异有统计学意义(P < 0.05)；两组术前、术后5 d及末次随访时Cobb角、伤椎体前缘高度丢失、椎管占位比较，差异均无统计学意义(P > 0.05)；两组术前ASIA评分、KLS评分比较，差异均无统计学意义(P > 0.05)；末次随访时，急诊手术组ASIA评分、KLS评分均高于择期手术组，差异均有统计学意义(P < 0.05)。结论：脊柱骨折伴截瘫急诊手术治疗效果优于择期手术，前者在减少并发症发生上具有优势，有利于术后护理和早期康复，值得予以重视。

Abstract: Objective: To compare the clinical efficacy of emergency operation and elective operation for spinal fracture with paraplegia. Methods: A retrospective analysis was performed on 118 patients with spinal fracture and paraplegia who received surgical treatment in our hospital from January 2017 to December 2020 and received postoperative follow-up. According to the subjective will and actual condition, they were divided into emergency surgery group (operation within 6 h after injury, 52 cases) and elective surgery group (operation within 4~7 d after injury, 66 cases). The operation time, intraoperative blood loss, postoperative drainage volume, and the occurrence of sur-gery-related complications were compared between the two groups. Cobb Angle, loss of anterior margin of injured vertebra height, spinal canal occupying, American Society of Spinal Cord Injury Score (ASIA Score) and Kunming Walking Scale (KLS) score were compared between the two groups at 5 days before and after surgery and 18 months of follow-up. Results: There is no significant dif-ference in operation time between the two groups (P > 0.05). The amount of intraoperative blood loss and postoperative drainage in the elective surgery group is less than those in the emergency surgery group, with statistical significance (P < 0.05). The incidence of surgery-related complica-tions in emergency surgery group is 9.62%, lower than 24.24% in elective surgery group, and the difference is statistically significant (P < 0.05). There are no significant differences in Cobb Angle, anterior margin height loss and spinal canal mass between the two groups before and after opera-tion and at the last follow-up (P > 0.05). There are no significant differences in preoperative ASIA score and KLS score between the two groups (P > 0.05). At the last follow-up, ASIA score and KLS score in the emergency surgery group are higher than those in the elective surgery group, with sta-tistical significance (P < 0.05). Conclusion: The effect of emergency operation on spinal fracture with paraplegia is better than that of elective operation; the former has advantages in reducing compli-cations and is beneficial to postoperative nursing and early rehabilitation, which deserves atten-tion.