胸腰椎爆裂骨折中柱损伤特点及相关手术治疗分析  

Characteristics of Thoracolumbar Burst Fracture with Mid Column Injury and Analysis of Relative Surgical Treatment

作　　者：杨斌辉[1,2] 张波[2] 孙茂民[1] 欧阳振[2] 夏春林[1] 

机构地区：[1]苏州大学医学部博习临床解剖学研究所暨解剖学系,江苏苏州215123 [2]陕西汉中3201医院骨科,陕西汉中723000

出　　处：《苏州大学学报（医学版）》2010年第5期1058-1062,共5页Suzhou University Journal of Medical Science

摘　　要：目的通过分析胸腰椎爆裂骨折中柱损伤的病理特点,探讨其与脊髓神经损伤的关系及手术治疗价值。方法对97例胸腰椎爆裂骨折,结合X线片、CT、MRI检查,测量椎管阻塞狭窄率,分析占位骨块形态、移位特征及椎间盘、后纵韧带损伤情况,选择不同手术方式,比较术前术后伤椎压缩百分比和后凸Cobb角及椎管狭窄率、脊髓神经功能恢复情况。结果术后所有患者骨折椎体均得到良好复位,随访6～28个月,4～6个月后88例植骨获得骨性融合,脊髓神经功能Frankel分级有1～3级恢复,术前、术后伤椎压缩百分比、后凸Cobb角及椎管狭窄率差异均有统计学意义(P<0.01)。对合并椎间盘损伤的9例,未做植骨融合,随访发现取除内固定后6例出现椎体高度及Cobb角不同程度丢失。结论胸腰椎爆裂骨折致椎管管径减小与脊髓神经损伤间有相互关系,椎管内不同形态的占位骨块预示着不同程度的瞬间暴力和脊髓神经原发损伤;选择适当的手术方式具有重要的临床价值;椎间盘损伤对脊柱稳定性的潜在影响应予以足够重视。Objective By analyzing the pathologic characteristics of the thoracolumbar burst fracture with mid column injury to explore the value of surgical treatment and the relationship between the spinal cord injury and the burst fracture. Methods With the combination of X-ray film,CT,MRI examination, in 97 patients with thoracolumbar burst fracture,the rate of spinal canal stenosis was measured. For the fracture fragments morphology,translocation,and intervertebral disc,posterior longitudinal ligament injuries,a different surgical method was selected,the percentage of wound vertebral body compression,kyphosis Cobb angle and the rate of spinal canal stenosis,spinal cord nerve function recovery were compared between preoperation and postoperation. Results After operation,all patients were reseted. Followed-up was performed from 6 to 28 months,in 88 cases bone graft fusion was obtained after 4 to 6months,1 ～ 3 levels were restored in Frankel grade of spinal cord nerve function recovery. Between preoperation and postoperation,the percentage of wounded vertebral body compression,kyphosis Cobb angle and the rate of spinal canal stenosis were significantly different（ P 0. 01） . For the 9 cases of combined intervertebral disc injury,fusion was not achieved in the 6 cases there were loss in vertebral body height and Cobb angle in various extent. Conclusion There is an interrelationship between thoracolumbar burst fracture caused by the reduction of spinal canal diameter and the spinal cord injury. Different forms of occupation of intraspinal bone fragments indicate different degrees of moment of violence and spinal cord primary injury. It is important to select the appropriate surgical method for clinic. The potential impact should be sufficient attention on the stability of intervertebral disc injury.

关 键 词：胸腰椎 爆裂型骨折 中柱损伤 手术治疗 

分 类 号：R683.2[医药卫生—骨科学]