经后路椎管减压椎弓根螺钉复位固定治疗中上胸椎骨折  

Treatment of mid-upper thoracic spine fracture with posterior decompression and pedicle crew fixation and reduction

作　　者：杨华[1] 邢维平[1] 宁旭[1] 尚显文[1] 张皓[1] 

机构地区：[1]贵阳医学院附属医院脊柱外科,550001

出　　处：《中华创伤杂志》2011年第9期779-782,共4页Chinese Journal of Trauma

摘　　要：目的分析经后路减压复位固定治疗中上胸椎骨折的可行性及手术特点。方法对17例中上胸椎骨折患者进行回顾性研究，统计并发症的发生，比较手术前后脊髓完全性损伤和不完全性损伤的功能状态，观察脊髓无损伤患者有无医源性损伤。结果术后无手术并发症发生。不完全性损伤6例（不完全性损伤组），随访时美国脊髓损伤协会（ASIA）脊髓功能分级提高1～3级；完全性损伤8例（完全性损伤组），随访时ASIA分级无提高。完全性与不完全性损伤组手术前后感觉评分间差异有统计学意义（F=476．47，P=0．000）。手术前后运动评分之间差异有统计学意义（F=46．75，P=0．000）。脊髓功能正常3例，随访时ASIA分级无降低，感觉和运动评分无变化。结论对于中上胸椎骨折患者，后入路手术能避免加重胸部合并伤及其他组织系统的合并伤，可以在骨折早期安全、有效解除包括椎管前方的脊髓压迫，从而有利于脊髓功能的恢复。Objective To analyze and summarize the feasibility and characteristics of the posterior spinal canal reduction and fixation in treating mid-upper thoracic spine facture. Methods A retro-spective study was made on 17 patients with mid-upper thoracic spine facture to record the complication, compare the functions of the patients with complete and incomplete spinal cord injuries before and after surgery and examine the iatrogenic injury in patients without spinal cord injuries. Results No compli- cation happened after surgery. Incomplete injury was found in six patients, whose ASIA scales were found to be increased for 1- 3 levels during the follow-up. While the complete injury was found in eight patients, whose ASIA scale remained unchanged during the follow-up. The sensory scores of both the incomplete injury group and complete injury group were processed with variance analysis and the results showed a significant difference between pre-operation and post-operation （ F = 476.47, P = 0.000）. The mean value between complete injury group and incomplete group was with high statistical difference （F = 31.46, P = 0. 000）. The variance analysis of the motor scores showed a significant difference between before and after operation （F = 46.75, P = 0. 000 ） and the mean value between complete and incomplete injury groups was with statistical difference （ F = 158.59, P = 0. 000）. There were three patients with normal spinal cord function, with no decrease of ASIA scale or no change of the sensory and motor scores. Conclusions For patients with mid-upper thoracic spine fracture, posterior spinal surgery is conducive to the recovery of spinal function, for it can safely and effectively avoid worsening the thoracic and other combined injuries and release spinal pressure including the pressure in front part of the spinal cannal.

关 键 词：脊柱骨折 胸椎 脊髓损伤 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]