胸腰椎骨折-脱位合并肌肉韧带及椎间盘撕裂的临床特点和手术治疗  

Clinical characteristic and surgical treatments for the fresh thoracolumbar fracture-dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures

作　　者：马泽民[1] 李晶[1] 吕国华[1] 王冰[1] 

机构地区：[1]中南大学湘雅二医院脊柱外科,长沙410011

出　　处：《中南大学学报（医学版）》2004年第2期215-217,共3页Journal of Central South University ：Medical Science

摘　　要：目的 :了解合并肌肉、韧带及椎间盘撕裂的胸腰椎新鲜骨折 脱位的临床特点 ,探讨该种损伤的手术方式的选择。方法 :回顾性分析 1 5例合并肌肉、韧带及椎间盘撕裂的胸腰椎新鲜骨折 脱位的临床资料。结果体格检查见骨折所对应的背部或腰部均有局限性隆起、触压有波动感 ,触诊可扪及断裂的棘上韧带和断裂的椎旁肌肉 ;MRI的共同表现是前纵韧带、椎间盘、椎旁肌肉和韧带断裂征象 ;手术探查见腰背部的局限隆起为皮下深层的积血积液、棘上韧带和椎旁肌肉断裂且断端不齐呈撕裂状 ,后纵韧带和纤维环断裂并伴有椎间盘组织破裂脱出。 5例行后路跨骨折椎经椎弓根固定复位者 ,压缩楔变的椎体均未任何复位 ;1 0例行后路骨折椎及相邻上下椎三节段经椎弓根固定复位者其压缩椎体均得以复位。结论 :合并肌肉、韧带及椎间盘撕裂的胸腰椎新鲜骨折 脱位是一种严重的脊柱损伤类型 ,临床局部体征和MRI表现以及术中所见对手术方式的选择有十分重要意义 ,经后路三节段椎根弓固定复位椎间盘摘除椎间植骨融合为治疗该种类型损伤的较好术式。Objective To analyze the clinical characteristics of fresh thoracolumbar fracture dislocation combined with paraspinal muscles, ligaments and intervertebral disc ruptures and to discuss the surgical procedure for the fracture.Methods The clinical materials of 15 patients who suffered from the disease mentioned above were retrospectively analyzed.Results The common physical examination findings were local bump in the dorsal or lumbar spine area and palpation of rupture ends of paraspinal muscles and ligaments.The common MRI manifestations were ruptures of anterior longitudinal ligament, intervertebral disc, paraspinal muscles, and spinous process ligaments. The common operative findings were similar to MRI findings. The fractured vertebrae in 5 patients who underwent posterior reduction and fixation with two segments pedicle screw did not restore their shape, but 10 patients who underwent posterior three segments pedicle screw reduction and fixation restored the shape of fractured vertebrae.Conclusion The fresh thoracolumbar fracture dislocation combined with paraspinal muscles,ligaments and intervertebral disc ruptures is a severe spine injury.Clinical physical examination and MRI appearance and intraoperative observation are important for the selection of operation procedure.The open reduction and internal fixation with pedicle screw rod system, and intervertebral resection and fusion via posterior approach is a good procedure for the special thoracolumbar fracture.

关 键 词：胸腰椎骨折 胸腰椎脱位 合并症 肌肉韧带 椎间盘撕裂 手术治疗 临床特点 

分 类 号：R687.3[医药卫生—骨科学]