重度陈旧性胸椎骨折脱位手术治疗  

Surgical treatment of obsolete severe thoracic spine fracture and dislocation

作　　者：于海龙[1] 杨会峰[1] 郭明明[1] 谢雁春 刘军[1] 

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016

出　　处：《临床军医杂志》2016年第9期896-897,共2页Clinical Journal of Medical Officers

摘　　要：目的探讨重度陈旧性胸椎骨折脱位的治疗方法及效果。方法自2010年1月至2014年6月,沈阳军区总医院共收治11例重度陈旧性胸椎骨折脱位患者。所有患者均为车祸伤。依据术前X线、CT三维重建检查,确定胸椎骨折脱位程度,其中,Ⅲ度4例,Ⅳ度4例,Ⅴ度3例。Ⅲ度脱位采用传统后路撑开复位植骨融合内固定术;Ⅳ度脱位采用后路椎体部分骨折块切除脊柱短缩钉棒系统内固定术;Ⅴ度脱位采用后路经伤椎水平截骨、脊柱短缩、钉棒系统内固定术。术后复查X线、CT三维重建,以明确胸椎骨折复位效果。结果本组患者均获得9-24个月的随访,平均随访时间为20个月。术后X线、CT三维重建检查证实脊柱稳定性良好;无感染,切口Ⅰ期愈合;无内固定松动、断裂等并发症。结论针对重度陈旧性胸椎骨折脱位的程度,采取不同的手术治疗策略,可有效恢复脊柱序列及生物力学稳定性。Objective To explore the methods and clinical outcome of surgical treatment of obsolete severe thoracic spine fracture and dislocation. Methods A retrospective study was performed on 11 patients with obsolete severe thoracic spine fracture and dislocation received in the General Hospital of Shenyang Military Command from January 2010 to June 2014. The injury cause of all the patients was traffic accident. The degree of thoracic spine fracture and dislocation were determined by the preoperative X-ray,CT three-dimensional reconstruction. Among all the patients,4 cases were classified into Ⅲ degree dislocation,4 cases into Ⅳ degree dislocation,and3 cases into Ⅴ degree dislocation. Patients with Ⅲ degree dislocation received traditional posterior open reduction,bone graft fusion and internal fixation. Patients with Ⅳ degree dislocation received partial removing of fractures and the spine shortening. Patients withⅤ degree dislocation received bone cut through injury vertebral levels and screw rod fixation system of shortened spine. Postoperative review of X-ray and CT slices was performed in order to make the effect of thoracic spine fracture clear. Results After surgery,the mean follow-up period was 20 months（ 9 to 24 months）. Spinal stability was good according to postoperative X-ray,CT three-dimensional reconstruction. There was no infection,fracture healing by first intention,loosening or breaking of the internal fixators,nonunion,or other complications. Conclusion Different surgical treatment strategies are made according to the different degrees of severe thoracic spine fracture and dislocation,which can effectively restore spinal sequence and biomechanical stability.

关 键 词：胸椎 骨折 脱位 外科治疗 

分 类 号：R687.3[医药卫生—骨科学]