多节段非相邻型脊柱骨折的致伤机制及伤情特点  

Traumatic mechanisms and conditions of multiple-level noncontinuous spinal fractures(MNSF)

作　　者：王洪伟[1] 王许可[1] 李长青[1] 周跃[1] 

机构地区：[1]第三军医大学附属新桥医院骨科,重庆市400037

出　　处：《中国矫形外科杂志》2013年第2期132-135,共4页Orthopedic Journal of China

基　　金：国家863支撑计划分课题(编号:2011AA030106);军队临床高新技术重大项目(编号:2010gxjs072)

摘　　要：[目的]分析多节段非相邻型脊柱骨折的致伤机制及伤情特点,以提高脊柱骨折的预防及诊断水平。[方法]总结2001年5月～2011年5月收治的167例多节段非相邻型脊柱骨折患者资料,其中男89例,女78例,年龄16～89岁,平均51.0岁,并进行致伤机制及伤情特点分析。[结果]167例患者中年龄分布主要集中在40～49岁,占22.8%(38/167)。≤49岁各年龄组段男性人数均较女性多,≥49岁各年龄组段男性人数均较女性少。高坠伤是主要致伤原因,占32.9%(55/167)。167例病例中胸椎+腰椎骨折,胸椎+胸椎骨折,腰椎+腰椎骨折所占比例较高,分别为32.9%(55/167)、22.2%(37/167)、19.2%(32/167)。高坠伤最易导致腰椎节段的跳跃性骨折,摔伤和无明显诱因组最易导致胸椎和腰椎节段的跳跃性骨折,车祸伤和重物砸伤最易导致颈椎和胸椎的跳跃性骨折,生活伤最易导致胸椎节段的跳跃性骨折。按唐三元法,跳跃性骨折分型为A型49例,B型80例,C型38例。高坠伤、车祸伤和重物砸伤导致的神经损伤和合并伤发生率较高。按ASIA脊髓损伤分级,A级、B级、C级、D级分别占13.8%(23/167)、4.8%(8/167)、6.0%(10/167)和17.4%(29/167)。[结论]脊柱跳跃性骨折中,高坠伤是主要致伤因素,胸椎和腰椎是多节段非相邻型脊柱骨折的好发部位,应根据其致伤机制及伤情特点来进行预防及诊断。[ Objective] To analyze the traumatic mechanisms and conditions of multiple -level noncontinuous spinal fractures（MNSF） treated in our department in order to improve their prevention and diagnosis. [ Method] A review of 167 cases（89 males ,78 females）of spinal fractures were performed to analyze. Their ages raged from 16 to 89 years, with a mean value of 51.0 years. [ Result] The 40 to 49 year - old patients formed the largest group, accounting for about 22. 8% （38/167）. Males exceeded females in all the ≥ 49 age groups. Failing were the main cause for the spinal fracture,accounting for about 32. 9% （55/ 167） of etiological factors. Thoracic ＋ lumbar vertebral fractures,thoracic ＋ thoracic vertebral fractures,lumbar ＋ lumbar vertebral fractures accounted for 32. 9% （55/167）, 22. 2% （ 37/167 ）, 19. 2% （ 32/167 ） respectively. Lumbar multiple - level noncontinuous spinal fractures were more likely caused by falling, thoracic ＋ lumbar fractures were more likely caused by slipping and no definite cause group. Cervical ＋ thoracic fractures were more likely caused by road traffic accidents and direct collision with a blunt object,thoracic ＋ thoracic fractures were more likely caused by daily life injury. According to Tang~ classifi- cation method,there were type A in 49, type B in 80,type C in 38. According to ASIA scale, the rates of spinal cord in level A, B,C and D were 13. 8% （23/167） ,4. 8% （8/167） ,6. 0% （10/167） and 17.4% （29/167） respectively. [ Conclusion]The epidemiologicl survey reveals that the main factors for multiple - level noncontinuous spinal fractures is failing, the most common fracture vertebrae located in the thoracic and lumbar region ,we should make prevention and diagnosis on the basis of traumatic mechanisms and conditions of multiple - level noncontinuous spinal fractures.

关 键 词：脊柱骨折 多节段 致伤机制 诊断 预防 

分 类 号：R687.3[医药卫生—骨科学]