多节段非相邻型脊柱骨折32例临床分析  

Clinical Analysis of 32 Cases with Multi-level Noncontiguous Spinal Fractures

作　　者：张绪华[1] 申小青[1] 吴明宇[1] 张克云[1] 

机构地区：[1]湖南怀化医专附属医院暨怀化市第三人民医院骨科,湖南怀化418000

出　　处：《医学临床研究》2008年第7期1208-1210,共3页Journal of Clinical Research

摘　　要：【目的】探讨多节段非相邻型脊柱骨折（MNSF）的特点、诊断与手术治疗方式。【方法】回顾性分析本院行手术治疗并获得随访的32例MNSF患者的临床资料，观察其ASIA分级评分、伤椎椎体前缘高度及后凸畸形矫正率的变化，同时行CT扫描，观察骨折的愈合情况。【结果】32例患者共累及椎体70个节段，关键损伤部位骨折类型以爆裂骨折和骨折脱位为主（84．4％）。随访时间2～6年，平均3．5年，均达骨性愈合。脊髓不完全性损伤病例（B、C级），术后AsIA分级分别提高1～2级，感觉运动评分随访时与术前比较有显著性差异（P〈0．05）；脊髓完全性损伤病例（A级）ASIA分级与评分随访时与术前比较均无显著性差异（P〉0．05）。【结论】MNSF合并损伤多、易于漏诊或延误诊断，治疗上应明确多节段骨折的关键部位及骨折的性质，根据多节段脊柱骨折的类型选择相应的固定融合节段。[Objective]To study the characteristics, diagnosis and surgical treatment of multi-level noncon- tiguous spinal fractures （MNSF）. [Methods]The clinical data of 32 patients with MNSF operated and fol- lowed-up in our hospital were analyzed retrospectively, The grade score of the Spinal Injury Association （A- SIA）, and the change of the height of vertebra and the angle of kyphotic deformity and the fusion condition were observed by CT scanning. [Results]The average followed-up time was 3, 5 years ranged from 2 years to 6 years, Bone union was achieved in all patients. Totally 70 segments were involved in 32 cases, and the frac- ture types of the key injury part were burst fracture and fracture-dislocation mostly. Followed-up results showed that the post-operative ASIA grade of the cases with incomplete spinal cord injury （ASIA grade B and C） improved 1 or 2 grades, and there is significant statistical difference （ P 〈0.05） among the sensory and motor scores compared with pre-operation. The ASIA grades of the cases with complete spinal cord injury could not be improved, but the sensory and motor scores were improved average 18.7 and 14.6. [Conclusion] MNSF is characterized with tremendous force, complex mechanism and many complicated symptoms, so it is easy to miss or delay diagnosis. The key location and the characteristic of MNSF should be clearly identified for the treatment, and the internal fixated area should be determined appropriately according to the types of MNSF.

关 键 词：脊柱骨折 

分 类 号：R683[医药卫生—骨科学]