过伸复位内外减压治疗胸腰段骨折脱位并脊髓损伤

Treatment of thoracolumbar spinal fracture and dislocation with spinal cord injuries by hyperextensive reduction and internal and external decompression

目的研究胸腰段骨折脱位并脊髓损伤过伸复位中，手术台胸板上升和脊椎后伸整复骨折脱位间量的关系和变化规律。方法用多功能手术台、Ｃ形臂Ｘ线机对３１例胸腰段骨折脱位患者进行术中过伸复位研究。通过对手术台胸板上升和受损脊椎过伸整复骨折脱位两变量相关回归分析，总结出直线回归方程。对整复过程变化规律也进行了研究。结果脊柱受损后弓角和手术台胸板上升最佳矫正角线性方程为：Ｃ床＝３９．６２９＋０．２５４Ｂ，其矫正过程呈现双曲线变化规律。经５６例患者应用该方程结果表明：完全复位率为８９％，较对照组提高了５９％。脊髓功能恢复有效率，完全瘫（Ａ→Ｂ）为２１．４％，不全瘫为１００％。结论应用线性方程过伸复位，选择性脊髓内外减压、纵向牵引，可有效地提高胸腰段骨折脱位的整复率。

Objective To study the lineal relation and its changing rule between plastron raising on the surgical table and reducing the fracture and dislocation by the spinal stretch when treating thoracolumbar spinal fracture and dislocation with hyperextensive reduction. Methods 31 cases of thoracolumbar fracture and dislocation have been studied during surgically hyperextensive reduction with multipurpose surgical table and C type X ray machine. The lineal regressive equation is concluded through the analysis on the two relative regression varieties between plastron raising on the hyperextensive reduction surgical table and the reduction of the fracture and dislocation by streathing back injured spine. The changing rule of reduction process is also studied. Results The best orthopaedic aligning angle equation between the injured spine back arch angle and plastron raising on the surgical table is as follows: C bed =39 629±0 254 B . The aligning process rule occurs as hyperbola curve, and 56 patients have applied the above equation and shows: Complete reduction rate is 89%, 59% higher than reference group. The recovering effectivity of the spinal cord function of complete paraplegia (A→B) and incomplete paraplegia is 21 4% and 100% respectively. Conclusion Applying lineal equation to hyperextensive reduction, selectively with spinal cord internal and external decompression, and longitudinal traction may effectively raise the reductional rate of thoracolumbar spinal fracture and dislocation, which creates good environment for the recovery of spinal cord function.