处理不当的胸腰椎骨折伤后3~8周内的手术治疗

Surgical Treatment within 3～8 Weeks Post-traumaticly for Inappropriately Treated Thoracolumbar Fractures

目的探讨初期治疗失当的胸腰椎骨折在伤后3～8周内手术治疗的效果。方法1998年10月～2005年10月共收治治疗失当的胸腰椎骨折患者28例，在伤后3～8周内行手术治疗，回顾性分析其临床资料和治疗效果，其中12例为有手术指征（5例爆裂性骨折，7例屈曲压缩性骨折）而未及时手术者，16例已行后路复位术但椎体压缩复位不满意或脱位、后凸畸形未纠正。结果13例伤后3～6周者均行经后路椎弓根复位固定术，术后压缩椎体高度恢复80％以上；15例伤后6周以上者，行经前路椎体切除植骨融合术，术后后凸畸形明显改善，骨折愈合良好。结论对于手术处理不当和有手术指征而未及时手术的胸腰椎骨折病例，在伤后3～8周内根据具体的情况采用合适的手术方式依然能够使骨折复位，纠正脱位及后凸畸形。

Objective To explore the effect of surgical treatment within 3 - 8 weeks after injury for inapporiately treated thoracolumbar fractures. Methods 28 cases of inappropriately treated thoracolumbar fractures were admitted from October 1998 to October 2005. In which 12 cases with surgical indications were not operated on, 16 cases were operated on but without satisfactory results, including vertebral body compression, dislocation or kyphosis was not corrected. Results 13 cases were operated on through posterior approach within 3 - 6 weeks post-traumaticly, and the vertebral body height was improved over 80% of normal height. 15 eases with fracture period more than 6 weeks received anterior approach procedure, and kyphosis improved obviously and fracture healing Well postoperatively. Conclusion To thoracolumbar fracture cases which are not treated appropriately, good result also can be achieved with appropriate surgical strategies taken according to concrete circumstance of each case in 3 - 8 weeks after injury.