非相邻多节段脊柱骨折的诊断与手术治疗

The diagnosis and surgical treatment of noncontiguous spinal fractures

目的:探讨非相邻多节段脊柱骨折(multi-levelnoncontiguousspinalfractures,MNSF)的受伤机制、诊断与手术治疗方式。方法:对我院1991年1月至2002年1月手术治疗并得到随访的36例非相邻多节段脊柱骨折患者的临床资料,按ASIA分级、感觉运动评分进行回顾性分析。结果:例36MNSF患者共累及椎体78个节段,关键损伤部位骨折类型以爆裂骨折和骨折脱位为主。脊髓不完全性损伤病例(B、C级),术后ASIA分级分别提高1￣2,级感觉运动评分随访时与术前比较有显著性差异(P<0.05);脊髓完全性损伤病例(级)AASIA分级无改善,感觉运动评分随访时与术前比较无显著性差异,但分别平均提高9.3分和11.3分。结论:MNSF具有损伤暴力大、致伤机制复杂、脊髓损伤严重、合并损伤多、易于漏诊或延误诊断等特点,治疗上应明确多节段骨折的关键部位及骨折的性质,并根据多节段脊柱骨折的类型选择相应的固定融合节段。

Objective:To study the mechanism,diagnosis and surgical treatment of multi-level noncontiguous spinal fractures(MNSF).Method:36 cases of MNSF were reviewed retrospectively.The Spinal Injury Association(ASIA),sensory and motor scores were analysised.Result:Totally 78 segments were involved in 36 cases of MNSF,follow-up results(average 4.5 years) showed that,cases among incomplete spinal cord injury (ASIA grade B and C),the ASIA grade improved 1 or 2 grades and there is statistical significant difference(P<0.05) among the sensory and motor scores compared with pre-operation,cases among complete spinal cord injury,the ASIA grades could not be improved,but the sensory and motor scores were improved average 9.3 and 11.3.The internal fixated area should be selected appropriately according to the types of fractures.Conclusion:The diagnostic expression should define the key location and the characteristic of MNSF.The internal fixated area should be determined appropriately according to the types of fractures of MNSF.