多节段脊柱骨折的治疗

Diagnosis and Treatment of Multi Level Spinal Fracture

目的探讨多节段脊柱骨折的损伤机制,伤情特点及诊治方法。方法对于1998年10月至2003年12月期间脊柱多阶段骨折进行回顾性分析。52例多节段骨折,相邻型33例(63.5%),非相邻型19例(36.5%),其中胸腰段损伤30例(57.5%),50例(96%)伴有神经损伤,脊髓功能按Frankel分级,A级11例,B级17例,C级15例,D级7例,E级2例,平均年龄38岁,延迟诊断19例。损伤原因以高处坠落(55.8%),交通事故(25%)为主。保守治疗28例,手术治疗24例,除7例行胸椎单纯减压以外,颈椎、胸腰段、胸椎均行切开减压并不同内固定器械固定,计有Orion1例,TSRH1例,Dick4例,SF2例,RF3例,AF2例,CD4例,固定椎体跨2节到4节不等。结果经过平均16.5个月随访,52例多节段骨折均获骨性愈合,脊髓功能改善1级者21例,改善2级者11例,无改善者20例。其中FrankelA级11例,仅有2例有改善。结论多发性脊柱骨折发生率较低,易漏诊,伤情重,合并伤多,多伴有脊髓损伤,以青壮年男性多发。高空坠落,交通事故是常见原因。损伤的康复取决于脊髓受伤程度,手术积极干预,对患者康复有帮助。

Objective To study the injury mechanisms, injury characteristics, diagnosis and treatment of multi level spinal fracture. Methods Fifty two cases of multi level spinal fracture were retrospectively analyzed among 820 spinal fracture cases, which were admitted from October 1998 to December 2003. Sixty-nine percent of the patients were no older than 40 years and the mean age was 38.33 cases（63.5%） were continuous spinal injury and 19 cases （36.5%） were non-continuous spinal injury. The injury mostly occurred at the thoracolumbar level（57. 7%）. The patients suffered from falling injury and traffic accident were 80.8% in the group. According to Frankel classification,11 cases belonged to grade A, B 17cases, C 15cases, D 7cases, E 2cases. Twenty-four cases were treated with surgery, of which 17 cases were undergone internal fixation combined with decompression. Twenty-eight cases were treated with no operation. Results All patients were followed up for an average of 16.5 months and obtained solid fusion of fractures. Thirty-two cases（61. 5%） improved 1 or 2 grades of spinal cord function according to Frankel classification. Conclusion The incidence of multi level spinal fracture is low, and the paitents often have different complications and compound injuries, most of them are associated with spinal cord injuries. It is relatively common in adolescent and adult male patients, and the most common injury factors are falling injury and traffic accident. The recovery lie on the degree of spinal cord injury, and the treatment of surgery is helpful to the healing of patients.