胸腰椎骨折体位复位与器械复位的比较研究

Comparison between Postural Reduction and Instrumental Reduction in the Treatment of Thoracolumbar Vertebra Fracture

目的：对２４例胸腰椎骨折患者的体位复位与器械复位效果进行临床比较研究．方法：患者全麻后行过伸俯卧复位并摄片（术中片），然后再行器械复位固定并摄片（术后片）．对“术中片”、“术后片”及入院诊断时的“术前片”病椎椎前高和病椎上下椎间隙前高的变化进行比较分析．结果：（１）椎前高恢复在体位复位和器械复位时基本一致；（２）椎间隙前高度在器械复位后可恢复更高；（３）部分病椎压缩超过２／３时，两种复位效果均不佳；（４）下腰椎骨折的两种复位效果不满意．结论：脊椎骨折复位效果与病椎松质骨压缩程度有关．器械复位的力量为一种间接张力，其对病椎的复位作用若要在体位复位基础上进一步提高，不仅受骨折程度影响，而且受软组织结构影响．因此，体位复位是胸腰椎骨折复位的主要力量，而器械复位作用相对较弱，重点在于维持复位效果．

Aim: To study the effect of the treatment of thoracolumbar vertebra fracture by clinical comparison between postural reduction and instrumental reduction in 24 paients. Methods: Under general anesthesia postural reduction in stretching prone position was performed at first, then instrumental reduction and fixation were conducted. Radiographic films were taken after the two reductions, respectively, and a comparison was made between the two films and the fracture film according to the changes of prevertebral height of both diseased vertebra and adjacent to superior and inferior intervertebral spaces. Results: (1) The recovery of prevertebral height was basically identical in both postural and instrumental reductions. (2) The recovery of prevertebral height of intervertebral spaces was more significant in instrumental reduction. (3)The two reductions were not very effective in the cases of compression of diseased vertebra more than two thirds. (4) In the cases of lower lumbar vertebra fractures, the effect was unsatisfactory by either reduction. Conclusion: The result of reduction of vertebra fracture depends on the quantitative change of spongy bone of diseased vertebra. Instrumental reduction exerts only an indirect tension and its presumed additional effect on the base of postural reduction would be limited by the degree of fracture as well as by the soft tissue structure. Hence, the postural reduction is the fundamental method in reduction of thoracolumbar vertebra fracture, while instrumental reduction exerts only a relative weak effect and is particularly useful for the maintenance of the result of postural reduction.