胸腰椎骨折伴脊髓损伤手术方式选择

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胸腰椎骨折伴脊髓损伤手术方式选择

林本丹　钟志刚　邱雪立　胡奕山　周来喜

摘　要　目的:探讨胸腰椎骨折伴脊髓损伤前后路手术各自的优缺点、适应证以及内固定物的选择。方法:回顾1992年1月～2000年4月手术治疗胸腰椎骨折伴脊髓损伤53例,其中后路手术43例,前路手术10例;总结手术方法及手术疗效。结果:获6个月以上随访41例,脊髓神经功能术前为A 级3例,术后均无恢复;其他在术后均有1-3级恢复;前后路手术对神经功能恢复无法做比较;椎体复位后路手术43例有11例欠佳,前路手术10例均达解剖复位。结论:前后路手术各有其较明确的适应证,应按照受伤节段、CT 显示椎骨受压情况及神经损伤程度进行选择;后路手术存在远期或取钉之后椎体高度再丢失问题,前路因其能达到生物学固定而远期稳定效果良好。

关键词　脊柱骨折;　胸椎;　腰椎;　内固定

中图分类号　R683.1 文献标识码　A 文章编号　1005-8478(2001)02-0137-03

The Selection of operative Procedures for Thoraco -lumb ar Fracture Complicated with Spinal Cord Injury ∥L IN Ben 2dan ,ZHON G Zhi 2gang ,QIU X ue 2li ,et al.Depart ment of Orthopedics.Guangdong S hantou 515031

Abstract Objective :To explore the effects and indications of anterior or posterior approach operation to treat thoraco -lumbar fracture complicated with spinal cord injury ;to discuss the selection of the material of internal fixation.Methods :53cas 2es of thoraco -lumbar fracture accom panied with spinal cord injury were operated from Jan.1992to Apr.2000.43cases were treated by posterior approach operation and 10cases by anterior approach.Results :41cases were followed -u p over 6months.3cases that ASIA (American S pinal Injary Association )impairment scale of preoperation showed A had no recovery.Others were recovered from 1-3scale after operation.The level of recovery of spinal cord injury could not be compared between anterior ap 2proach and posterior approach.In 43cases of posterior approach operation ,11cases could not recover the height of vertebral body after operation.In all 10cases of anterior a pproach operation ,the fracture of vertebral body achieved anatomical reduction.Con 2clusions :The indications anterior a pproach and posterior approach operation could be defined according to the segment of injured vertebra ,the compressed position of spinal cord that was showed by CT and the impairment scale of s pinal cord.That the height of vertebral body lost again could be found in long -term follow -up in the posterior approach operation.The late result of the anterior approach operation was good because it could achieve the biologic fusion in the injured vertebral body.

K ey w ords Spinal fracture ;　Thoracic vertebrae ;　Lumbar vertebrae ;　Internal fixation

作者单位:汕头市中心医院骨科,　广东汕头　515031

作者简介:林本丹(19642),男,广东省汕头市人,副主任医师,医学硕士。

主研方向:脊柱外科与关节创伤外科 胸腰椎骨折是脊柱骨折中最常见的部位,常伴有

脊髓损伤。在治疗原则上,虽然手术时机已取得较相

对一致的意见,但对手术的入路即前后路选择和各入

路手术方式选择则仍存在较大争论,国内大型参考书

对此也未提出明确及客观的选择指标1。本文就53

例胸腰椎骨折伴脊髓损伤手术治疗作回顾性分析,并

对上述相关问题提出讨论。

1　临床资料

1.1　一般资料

1992年1月～2000年4月手术治疗胸腰椎骨折伴脊髓损伤共53例。其中男41例,女12例,年龄19～58岁,平均33岁。(1)致伤因素:交通事故伤28例,高处坠落伤14例,重物压砸伤11例。(2)受伤部位,单节段受累:T 118例,T 1215例,L 117例,L 27例;2节段以上受累:T 12～L 13例,T 11～T 122例,T 12～L 11例。(3)骨折按Macffee 分型,压缩骨折8例,爆裂骨折38例,骨折脱位7例。神经损害按ASIA 分级2,A 级5例,B 级15例,C 级22例,D 级11例。1.2　手术方法1998年6月以前病人均采用后路减压内固定方法,1998年6月以后根据病人脊髓受压部位、程度和

方向综合考虑,分别采取前、后路减压内固定。本组