脊髓损伤并四肢粉碎性骨折的治疗体会(附18例报告)

Treatment of Spinal Cord Injury Combined with Bone Fracture of Four Limbs

目的 :探讨脊髓损伤并四肢粉碎性骨折病人四肢骨折的处理。方法 :对 18例脊髓损伤并四肢骨折病例 ,急诊行椎管减压、复位及椎弓根钉板系统内固定术 ,并予激素冲击疗法 ,四肢骨折同时行切开复位加压钢板螺钉内固定加植骨术 ,配合使用促进骨愈合、扩张血管、及保护胃粘膜等药物及高压氧治疗。结果 :所有病例均获得随访 ,平均随访时间 2a 4个月。 18例四肢骨折均获临床骨性愈合 ,愈合时间 6～ 12周 ,平均 7.6周。无骨不连发生。其中 11例已取出内固定 ,无再骨折。结论 :脊髓损伤合并四肢粉碎性骨折的病例 ,早期在处理脊髓损伤的同时 ,四肢骨折采用坚强内固定加植骨术 ,可以预防四肢骨折术后骨不连的发生。便于护理 。

Objective:To investigate the management of the spinal cord injury following splintered fracture of four limbs.Methods:18 patiens with spinal cord injury combined by bone fracture of four limbs were treated by reducing the pressure in the vertebral canal and reestablishing the impaired vertebrae by means of nail and plate system under general anaesthesia.The bone fracture of four limbs were opened for reduction and the plate and bolt were used for internal fixation in addition to bone graft.After operation,drugs were administered to promote bone healing,expand blood vesel and safeguard the mucous membrane of stomach.Hyperbaric oxygen treatment was also used.Results:All the patiens were followed up for an average of 2.4 years.All the 18 cases of bone fracture of four limbs obtained clinical synostosis.The healing time was 6-12 weeks(7.6 weeks on the average).No non-healing occurred.among the 18 patiens,11 were taken out of the internal fixation,and none had refracture.Conclusion:In treatment of the spinal cord injury the bone fractures of four limbs should be handled by firm internal fixation and bone graft at the same time postoperative to prevent non-healing,which is beneficial to the nursing and rehibilitaion of the limbs.