胸椎骨折脱位的手术治疗

Treatment of thoracic fracture and dislocation

目的总结分析胸椎骨折脱位的临床特点，探讨手术治疗方式的选择和疗效。方法对2004年4月至2007年12月手术治疗的52例胸椎骨折脱位患者资料进行回顾性分析。52例患者骨折共累及70个节段，其中21例为多节段（两个节段以上）骨折。骨折AO分型：A1型15例，A2型3例，A3型5例；BI型2例，B2型3例；C1型3例，c2型19例，C3型2例。术前神经损伤ASIA分级：A级21例，B级4例，C级5例，D级8例，E级14例。后路减压植骨融合椎弓根内固定44例，前路减压植骨融合加内固定7例，前后联合人路1例。多节段固定21例，单节段固定31例。结果48例患者术后获12～56个月（平均32．4个月）随访，4例失访。术前椎体高度丢失平均43．6％，最终随访时为7．5％；术前Cobb角平均21．2°，最终随访时为6．2°。术后并发症：肺部感染5例，伤口感染1例，深静脉血栓1例，硬膜外血肿1例。其中21例术前ASIA分级为A级者无改善；2例B级者改善至C级，2例失访；5例C级患者中，2例改善至D级，1例改善至E级，2例失访；8例D级患者均改善至E级；14例E级无变化。结论胸椎骨折脱值的临床特点为损伤外力强大，损伤部位多在下胸段，中上胸椎骨折造成的脊柱脊髓损伤严重且多发伤合并率高。手术方式以后路椎弓根固定为主，中上胸椎骨折应采用长节段固定，下胸椎骨折可以采用短节段固定。对于不稳定性骨折，即使是合并完全性脊髓损伤，电应考虑早期手术减压并稳定脊柱，以利于患者的早期康复治疗。

Objective To analyze the characteristics and results of surgical treatment of upper-middle thoracic fractures. Methods From April 2004 to December 2007, 52 patients were treated surgically for thoracic fracture and dislocation. Multiple injuries or multiple fractures were found in 23 eases and multi-segmental fractures in 21. There were 23 cases of type A, 5 type B and 24 type C according to the AO thoracolumbar fracture classification. Twenty-one patients had complete neurological injury, 17 incomplete neurological injury 14 patients no neurological injury. Forty-four patients had posterior procedure, 7 patients anterior procedure and 1 patient combined procedure. Results Of these patients, 48 were evaluated clinically, radiographically and functionally for a minimum of 1 year （mean, 32.4 months） . At the time of follow-up, there were no hard ware failures. None of the preoperative 21 ASIA A patients had improvement in neurological function, but 12 patients obtained improved neurological function. Conclusions Thoracic fractures are characterized by a strong injury force, severe damaged spine and spinal cord, and a high incidence of multiple injuries. For optimal neurological recovery and rehabilitation, surgical decompression and stabilization should be considered for patients with unstable injury and even with complete neurological injury.