经胸骨柄“U”形切除入路治疗上胸椎爆裂骨折并截瘫  

Treatment of burst fracture of upper thoracic vertebra with paralysis through the "U" fenestration approach in the sternal manubrium

作　　者：丁真奇[1] 庄平[1] 康两奇[1] 刘晖[1] 郭志民[1] 

机构地区：[1]解放军第175医院(厦门大学附属东南医院)骨科全军创伤骨科中心,福建漳州363000

出　　处：《临床骨科杂志》2008年第1期1-3,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨经胸骨柄"U"形切除入路治疗上胸椎爆裂骨折的可行性及临床疗效。方法12例上胸椎爆裂骨折并截瘫患者,全部采用经胸骨柄"U"形切除入路行伤椎次全切除减压、植骨、颈椎前路钢板内固定术。结果随访1～7年,椎间植骨均愈合好,内固定无松动、断裂,无切口感染、颈前血肿、窒息、气胸、乳糜漏、肺部感染等并发症。9例术后感觉、运动神经功能均有不同程度改善。Frankel分级:术前A级6例术后恢复至B级1例、C级2例、3例无明显改善;B级1例恢复至C级;C级3例恢复至D级2例、E级1例;D级2例恢复至E级。结论经胸骨柄"U"形切除入路解决了低位下颈椎前方入路因胸骨柄遮挡带来的操作不便,又可避免切断胸骨、锁骨的相关并发症。通常能显露至T4,并能在直视下完成T3及以上椎体的前方减压、植骨和钢板内固定,是治疗上胸椎爆裂骨折理想的手术入路。Objective To explore the feasibility and clinic curative effect in the treatment of burst fracture of upper thoracic vertebra with paralysis through the ＂U＂ fenestration approach in the sternal manubrium. Methods 12 patients with the burst fracture of upper thoracic vertebra paralysis were treated through the ＂U＂ fenestration approach for anterior decompression and plate stabilization. Results All were followed up for 1-7 years. All got the fusion of bone graft. There was no occurrence of incision infection, asphyxia, pneumothorax, chyle leakage, pulmonary infection etc. 9 got motor and sensor recovery to Some extent. According to Frankel grading, in 6 of grade A, 1 was restored to B, 2 to C,3 had no obvious recovery; 1 grade B was restored to C; In 3 cases of grade C, 2 were restored to D, 1 to E ;2 cases of grade D were restored to E. Conclusions The ＂U＂ fenestration approach in the sternal manubrium can avoid not only the block of sternal manubrium with the anterior approach of lower cervical vertebra but also the complication of resecting of sternum or clavicle, and T4 vertebra could be approached. It is effective for burst fracture of upper thoracic vertebra.

关 键 词：上胸椎 脊柱骨折/外科学 截瘫 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]