早期后路椎管减压伤椎椎弓根螺钉内固定治疗中上胸椎骨折脱位  

Early posterior spinal decompression and vertebral pedicle screw fixation on injured vertebra in treatment of upper-middle thoracic spine fracture and dislocation

作　　者：贺仕雄[1] 韩毅[1] 蔡力[1] 姚国荣[1] 吴大鹏[1] 田宏宇[1] 冯枭[1] 

机构地区：[1]广元市第二人民医院脊柱外科,四川广元628017

出　　处：《临床骨科杂志》2011年第6期624-626,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨早期后路椎管减压伤椎椎弓根螺钉内固定治疗中上胸椎骨折脱位伴脊髓损伤的临床效果。方法对41例中上胸椎骨折脱位患者49椎采用早期后路椎管减压伤椎椎弓根螺钉内固定植骨融合,固定节段4～6节。患者均在72 h内手术。结果 41例均获随访,时间12～46(28±2)个月。脊髓神经功能按ASIA分级:A级6例恢复至B级4例,2例无恢复;B级10例恢复至C级6例、D级3例、1例无恢复;C级15例恢复至D级9例、E级2例,4例无恢复;D级6例恢复至E级3例,3例无恢复;E级4例仍为E级。椎体前缘高度:术前为35.36%±7.48%,术后纠正到91.48%±2.15%,末次随访时为90.56%±1.63%;Cobb角:术前为37°±8°,术后及末次随访为-4°±2°。骨折脱位完全复位,无内固定松动及断裂,末次随访均达到骨性融合。结论早期后路椎管减压伤椎椎弓根螺钉内固定是治疗急性中上胸椎骨折脱位的有效方法,能达到椎体早期复位和脊髓减压目的 ,利于患者早期康复。Objective To investigate the clinical effects of the early posterior spinal decompression and vertebral pedicle screw fixation on the injured vertebra in the treatment of upper-middle thoracic spine fracture and dislocation with spinal cord injury.Methods 41 cases with thoracic spine fracture and dislocation of a total of 49 vertebrae were undergone early posterior spinal decompression and pedicle screw fixation on the injured vertebrae and bone fusion within 72 h.The fixed segments were 4 to 6.Results 41 patients were followed up 12~46(28 ± 2) months.The spinal cord functions were classified by ASIA: Among the 6 cases in Grade A,4 cases recovered to B,2 cases did not recover;among the 10 cases in Grade B,6 cases recovered to Grade C,3 cases recovered to D,1 case did not recover;among 15 cases in Grade C,9 cases recovered to D,2 cases recovered tos E,4 cases did not recover;3 cases of 6 cases in Grade D recovered to E,3 cases did not recover;4 cases in Grade E remained in Grade 4.The anterior vertebral height was 35.36%±7.48% before survery.After correction it became 91.48%± 2.15%,and it was 90.56%±1.63% in the last follow-up;the Cobb angle was 37°±8° before surgery,and it became-4°±2° in the last follow-up after survery.Fracture-dislocation was completely reset.The internal fixation was neither loosen nor broken,and the bone fusion was reached in the last follow-up.Conclusions The early posterior spinal decompression and vertebral pedicle screw fixation on the injured vertebra is an effective way to treat upper-middle thoracic spine fracture and dislocation,it is able to reset vertebrae earlier and decompress spinal cord,and it is benefit for patients to recover soon.

关 键 词：椎管减压 伤椎 胸椎骨折脱位 脊髓损伤 

分 类 号：R68[医药卫生—骨科学]