手术治疗胸腰椎严重爆裂骨折（附36例临床分析）

Treatment of Severe Thoraco-Lumbar Bursting Fracture with Operation

报告手术治疗胸腰椎严重爆裂骨折３６例，碎骨块占椎管容积３０％以上。完全性截瘫１９例，不完全截瘫１７例。全组均经椎管减压、后路器械固定（Ｌｕｑｕｅ方法２９例，Ｇａｌｖｅｓｔｏｎ方法４例，Ｓｔｅｆｆｅｅ方法２例，Ｄｉｃｋ方法１例）。结果：３６例中３４例椎管减压充分，２例经ＣＴ复查证实碎骨块残留。３６例内固定术后近期脊柱均重获稳定，远期失稳３例。术后神经功能恢复好转率６９．４％。认为，ＣＴ扫描能清楚显示碎骨块突入椎管、神经受压情况，对爆裂骨折的诊断和治疗有重要意义。严重爆裂骨折椎管矢状径小于１０ｍｍ、伴有神经损伤应及早椎管减压内固定。

Thirty-six cases of severe thoraco-lumbar bursting fracture treated with operation are reported. The volume of fracture piecesin each case was more than 30 percent of the total volume of spinal cana Ninteen cases sustained complete paraplegia and 17 casesincomplete paraplegia. The posterior depression and internal fixation were performed on the above cases. Twenty-nine cases werestablized with lugue-instrumentation. Four cases were fixed with Galveston-instrumentation, and the others with Steffee-plate andDick nail. The result showed that 34 cases had sufficient depression and fracture pieces remained in 2 cases through CT rescanning.The spine was stabilized again after operation in 36 cases only 3 caseswere unstable in spine. The rate of nervous recovery was69. 4 percent. CT scanning can reveal the fracture pieces in spinal canal and compressed spinal cord. and is significant for the diagno-sis and treatment.Spinal canal depression and internal fixation should be performed on the cases with the sagittae (diameter lessthan 10 milimeter)and nerve injury as early as possible.