多节段胸腰椎骨折的个体化手术治疗  

Individualized surgical treatment of multiple level thoracic and lumbar fractures

作　　者：曹锦[1] 胡丰根[1] 胡奇志[1] 周文忠[1] 王大勇[1] 吴彧[1] 徐晓剑[1] 张旭晨[1] 

机构地区：[1]杭州师范学院医学院附属余杭医院骨科,浙江杭州311100

出　　处：《临床骨科杂志》2010年第6期632-634,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨不同类型胸腰椎多节段脊柱骨折（MSF）的相应治疗方法及疗效。方法 18例MSF患者中15例采用后路切开复位椎弓根钉棒系统内固定,3例采用后路复位内固定并椎管减压等手术方式,对患者术前与随访时的Franke1分级、伤椎椎体高度矫正率进行分析。结果 18例均获随访,时间5~48（14±7）个月,未出现内固定物松动、断裂。椎体高度由术前26%~72.5%（42.0%±12.5%）恢复至术后87.4%~99%（95.3%±2.1%）。术后Franke1分级,除2例A级仅截瘫平面有1~2个节段下降外,4例B级恢复至C级3例、E级1例;C级4例、D级5例均恢复至E级;3例E级仍为E级。结论为达到减压、恢复脊柱正常序列、重建脊柱稳定的目的 ,MSF应根据患者具体情况进行个性化治疗。Objective To study the surgical treatment method of multiple thoracic and lumbar fractures of different types and to evaluate its clinical effect.Methods 15 of 18 patients with multiple level thoracic and lumbar fractures were surgically treated through posterior approach by open reduction,internal fixation with pedicle screw-rod spine instrumentation,the others with open reduction internal fixation and selective vertebral canal decompression.The Frankel grade and fractured vertebra height of pre-operation and post-operation were analyzed.Results All cases were followed up for an average of 5~48（14±7） months.No implant failure and kyphosis deformity was found.The average fractured vertebra height was improved from pre-operative 26%~72.5%（42.0%±12.5%） to post-operative 87.4%~99%（95.3%±2.1%）.The paralysis level was declined for 1~2 levels in 2 cases.In 4 cases of Frankel grade B,3 were improved to C,1 to E.4 cases of grade C and 5 grade D were improved to E.3 grade E remained grade E.Conclusions The treatment of multiple level thoracic and lumbar spinal factures should be individualized in order to obtain decompression,restoring of the normal spinal structure and stability of spines.

关 键 词：脊柱骨折/外科学 个性化 

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