坠落伤致胸腰椎Chance骨折的诊断与外科治疗  

Diagnosis and surgical treatment of thoracolumbar vertebral Chance fractures caused by a fall

作　　者：王根林[1] 杨惠林[1] 蔡鑫[1] 史金辉[1] 唐天驷[1] 

机构地区：[1]苏州大学附属第一医院骨科,215006

出　　处：《中华外科杂志》2008年第10期741-744,共4页Chinese Journal of Surgery

基　　金：江苏省135重点学科基金资助项目（RC2003091）

摘　　要：目的探讨坠落伤致胸腰椎Chance骨折的诊断及短节段椎弓根螺钉系统治疗的疗效。方法回顾性分析2000年1月至2007年1月收治的由高处坠落伤所致16例Chance骨折患者的临床资料。所有患者均接受短节段椎弓根螺钉系统内固定治疗，术后通过影像学检查和Oswestry功能障碍指数综合评价其疗效。结果1例合并踝关节开放脱位与颅脑损伤，3例合并跟骨骨折，1例合并肾挫伤。无手术并发症。随访7个月～6年，平均2．6年。伤椎前缘高度由术前平均（63．3±6．8）％恢复至术后（92．1±4．0）％（P〈0．01），随访时为（90．7±3．6）％，与术后相比差异无统计学意义（P〉0．05）。随访时患者Oswestry功能障碍指数平均为4．9。结论高处坠落伤所致胸腰椎Chance骨折的合并伤及损伤机制不同于安全带型Chance骨折。短节段椎弓根螺钉系统内固定治疗Chance骨折疗效满意。Objective To explore the diagnosis of Chance fractures of thoracolumbar spine and the clinical efficacy of segmental pedicle screw instrumentation in the treatment. Methods The clinical data of 16 patients with Chance fractures from January 2000 to January 2007 were retrospectively analyzed. All patients were treated with segmental pedicle screw instrumentation. Radiology and the Oswestry Disability Index （ODI） were used to evaluate the efficacy. Results One case associated with open dislocation of ankle and craniocerebral injury, 3 cases with calcaneus fracture and 1 with kidney contusion. All cases were followed up from 7 months to 6 years, with a mean of 2. 6 years. There were no operation complications. The anterior vertebral body height of fracture vertebra was restored from preoperative （ 63.3 ±6. 8 ） % to postoperative （92. 1± 4. 0 ） % , at the follow-up （90.7 ±3.6 ） %. There was a significant improvement between preoperative and postoperative values （ P 〈 0. 01 ） and no difference between initial postoperative and final follow-up （ P 〉 0. 05 ）. The mean ODI was 4. 9. Conclusions The injuries associated with Chance fracture caused by a fall and its mechanism are different from those with the safety belt injury. The segmental pedicle screw instrumentation can rebuild spinal stabilization and restore spinal alignment in treatment of Chance fractures.

关 键 词：脊柱骨折 外科手术 诊断 治疗效果 

分 类 号：R686[医药卫生—骨科学]