胸腰椎爆裂骨折椎管内骨折块CT分型及对后路减压方式的意义

Surgical strategy in treatment of inter-vertebral-cannel bonegraft of thoracolumbar burst fractures through typing with CT

目的 总结胸腰椎爆裂骨折椎管内骨折块形态分型，并对不同分型的骨折块处理策略进行分析。方法 通过对136例胸腰椎爆裂骨折的CT观察，将突入椎管内的骨折块根据占椎管容积、完整性、部位分为A、B1、B2和C型，并总结不同分型的减压方式。结果 A型利用后纵韧带的弹性张力进行骨折块间接复位，B1型用骨刀切碎分离并去除骨折块，B2型用异形骨冲将骨折块直接冲入椎体后方，C型采用骨折块分离、切碎后取出。本组病例手术前后伤椎椎管狭窄明显改善，椎管减压充分，统计学处理差异显著（P〈0．01），随访时14例ASIA分级A级患者仅有部分神经根功能恢复，其余病例分别提高1-3级。结论 根据不同分型，采取不同的处理方法，取得较好的临床效果。

Objective To establish the inter-vertebral-cannel bonegraft type with CT in thoracolumbar burst fractures and discuss the different surgical procedures. Methods Through 136 cases CT scanning,the inter-vertebral-cannel bonegrdt of thoracolumbar burst fractures were classitied into A, B1, B2, C types. Different methods of treatment according to different types were reviewed. Results Type A was dealt with indirect decompression of spinal canal,type B1 with direct decompression,type B2 with hitting-in bonegraft into vertebral body,and type C with direct decompression. Condusion Different surgical procedures should be used according to different types of in- ter-vertebral-canal bonegraft.