中上段胸椎骨折脱位手术入路的选择  

The Choice of Surgery Approach in the Treatment of Middle-upper Thoracic Fracture and Dislocation

作　　者：徐丽明[1] 顾锐[2] 林野[2] 朱庆三[2] 

机构地区：[1]湖北省武汉市协和医院西区创伤外科,湖北武汉430056 [2]吉林大学中日联谊医院骨科,吉林130021

出　　处：《实用骨科杂志》2010年第6期401-403,共3页Journal of Practical Orthopaedics

摘　　要：目的复习一组内固定治疗中上胸椎骨折脱位的临床资料,探讨不同手术入路行内固定的治疗效果及理论依据。方法自2002年11月至2007年12月,吉林大学中日联谊医院共手术治疗中上胸椎骨折脱位32例,其中23例行后路椎弓根螺钉内固定治疗中上胸椎骨折脱位,9例行前路手术钢板内固定治疗中上胸椎骨折脱位。结果所有患者均获得随访,随访时间3-48个月,平均25.5个月。均无术中严重并发症,伤椎前缘高度由术前平均40.4%恢复到术后平均90.3%;脊髓不完全损伤的患者ASIA分级提高1-2级,脊髓完全损伤的患者感觉运动评分有不同程度上升,平均上升21.7分。结论对于不伴有脱位的T1-3骨折,无论新鲜或陈旧骨折,低位下颈椎及经胸骨柄入路有明显的优势;对于T4-9骨折脱位患者前路损伤大,倾向于后路手术。Objective To review a group of clinical data of surgery implanting treatment middle-upper thoracic fracture and dislocation and explore the clinical effect.Methods Through the retrospective analysis of 32 patients of middle-upper thoracic fracture and dislocation,following time from 3 months to 48months,average 25.5 months.Results All of the cases have not serious compliment.Anterior height of vertebral body has been recovered from40.4 percent to 90.3 percent after operation;the patients with incomplete spinal cord injures improved one to two grade,according to ASIA grade of spinal cord injury;the patients with complete spinal cord injures improve 21.7 scores on average,according to Sensory and Motion Scores.Conclusion The lower anterior cervical approach and episternal approach are very good for T1 to T3 fracture without dislocation.Posterior approach is benefit for T4 to T9 fracture with dislocation.

关 键 词：胸椎 骨折 脱位 内固定 手术入路 

分 类 号：R683.2[医药卫生—骨科学]