胸腰椎C型骨折的外科治疗  

Surgical treatment of type-C thoracolumbar fractures

作　　者：谢陶敢[1,2] 陈其昕[1] 李方才[1] 方杰[1] 

机构地区：[1]浙江大学医学院附属第二医院骨科 [2]浙江省诸暨市人民医院骨三科311800

出　　处：《中国骨伤》2008年第1期13-15,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨胸腰椎C型骨折的手术入路和内固定方法。方法:本组胸腰椎C型骨折患者28例,男20例,女8例;年龄20～54岁,平均38.5岁。节段分布:T112例,T123例,L111例,L28例,L33例,L41例。均采用单纯后路长节段固定或后路长节段固定加前路植骨融合的方法治疗。对获得随访12～20个月的26例患者的X线和CT片进行分析,测量术前、术后、术后1周及1年时椎体高度、冠状位和矢状位Cobb角、椎管占位百分率。观察神经恢复和腰背痛发生以及内固定失效情况。结果:本组椎体高度丢失由术前平均37.4%减少到6.8%,冠状位畸形完全纠正,矢状位Cobb角由平均22.3°恢复至5.6°,椎管占位由术前平均33.7%恢复至5.9%,差异有统计学意义(P<0.05)。随访1年时上述各指标较术后1周时无明显改变,差异无统计学意义(P﹥0.05)。神经症状除8例完全损伤无恢复外,其他不全瘫者均有1～3级改善。腰背痛发生率19.2%,Denis分级评估P41例,P32例,P22例。无内固定失效病例。结论:单纯后路长节段固定或后路长节段固定加前路植骨融合治疗胸腰椎C型骨折是可靠、有效的方法,近期疗效满意,远期有待进一步观察。Objective ：To explore the operative approach and method of internal fixation for the treatment of type-C thoraeolumbar fractures. Methods：Twenty-eight patients （male 20, female 8, ranging in age from 20 to 54 years, with an average of 38.5 years ） with type-C thoracolumbar fractures were invovled in the study. Distributed segments involved Tu in 2 patients ,T12 in 3 patients,Li in 11 patients,L2 in 8 patient,L3 in 3 patients and L4 in 1 patient. Twenty-six patients were followed up （range from 12 to 20 months）. According to the analysis of X-ray and CT image,height of vertebral body,Cobb angle on sagittal and coronal plane and the percentage of occupancy of vertebral canal were measured. The recovery of nerve, happening of back pain and the failure of internal fixation were observed. Results：The preoperative averaging height-loss decreased from 37.4% to 6.8% and the deformation of coronal plane was completely rectified. The preoperative averaging Cobb angle on sagittal plane recovered from 22.3°to 5.6° and the preoperative occupancy of vertebral canal averaging recovered from 33.7% to 5.9%. The difference was statistically significant （P〈0.05）. Moreover, after 1 year follow-up,the changes of the above-mentioned index was no statistically significant （P〉0.05）. Except for 8 patients with complete nerve damage losing the possibility of recovery,the others with incomplete nerve damage obtained 1 to 3 degree＇s improvement. The ratio of back pain occurrence was 19.2%. There was no failure of internal fixation. Conclusion ：The treatment of thoracolumbar type-C fractures with simple posterior long-segment internal fixation or posterior long-segmental fixation added by anterior autograft fusion is a reliable and effective method. The short-term therapeutic effect is satisfactory and the long-term therapeutic effect is to be further observed.

关 键 词：胸椎 腰椎 C型 骨折 骨折固定术 内 

分 类 号：R683.420.5[医药卫生—骨科学] R683.205[医药卫生—外科学]