后路序列渐进撑开复位治疗严重中上胸椎重叠性骨折脱位

Sequential distraction and reduction for upper-middle thoracic fracture with severe overlapping dislocation

目的:探讨单纯后路多棒序列撑开复位治疗严重新鲜中上胸椎重叠性骨折脱位的可行性及疗效。方法:2006年3月至2008年3月共收治12例严重新鲜中上胸椎重叠性骨折脱位患者,术前神经功能Frankel分级A级11例,C级1例。AO分型为B1型1例,B2型2例,C1型3例,C3型6例。骨折断端重叠小于1个椎体者3例,介于1到2个椎体之间者7例,重叠超过2个椎体者2例。常规彻底减压后,所有病例均采用单纯后路多棒序列渐进撑开复位,即以4～5根不同曲度的内固定棒逐步撑开椎弓根钉,缓慢复位脱位椎体,横突间及剩余椎板间植骨融合后牢固固定,随访观察治疗效果。结果:术后残留轻度背痛1例,适应良好;并发褥疮1例,换药后痊愈;并发双髋骨性关节炎1例,理疗后症状消失;泌尿系统感染2例,予口服抗生素治疗后痊愈。术后X线片示脱位椎体完全复位11例,残留Ⅰ度滑脱1例,胸椎后凸恢复为15°～39°。术后7d支具保护下所有患者均借助轮椅恢复部分自理能力。12例患者随访6～24个月,平均18个月。至末次随访时,胸椎后凸角度无明显丢失,内固定无松动、断裂及移位,植骨融合良好。神经功能损伤者中1例FrankelA级恢复至B级,1例C级恢复到D级,A级患者中1例会阴部感觉轻度改善,3例患者截瘫平面下降2个节段,其余患者无明显变化。结论:单纯后路序列渐进撑开复位是治疗严重新鲜中上胸椎重叠性骨折脱位的较好选择。

Objective：To investigate the feasibility and clinical outcome of sequential distraction and reduction for upper-middle thoracic fracture with severe overlapping dislocation.Method：12 patients suffering severe fresh upper-middle thoracic fracture complicated with overlapping dislocation from March 2006 to March 2008 were reviewed retrospectively.According to AO classification,there were 2 B1 type,1 B2 type,3 C1 type and 6 C 3 type.As for overlapping distance,there were less than 1 vertebra in 3 cases,between 1 and 2 vertebrae in 7 cases and over 2 vertebrae in 2 cases.The preoperative Frankel scale was A class in 11 cases,C class in 1 case.After complete decompression,sequential distraction and reduction,and autograft bone fusion via posterior pedicle instrumentation were conducted in all cases.The clinical outcome was followed up.Result：As for complications,there were 1 mild back pain,1 bilateral hips osteoarthritis,1 pressure sore and 2 urinary infection,all healed well after conserva...更多tive treatment.Postoperative radiograph showed complete recovery of thoracic length and alignment in 11 of 12 cases,except 1 case having Ⅰ degree transplacement.All patients resumed partial self-dependence activity by wheel-chair about 7 days after operation.The mean thoracic kyphosic angle restored to 33°（range,15°-39°）with no obvious correction loss or instrument failure after 18 months（6-24 months）follow-up,and the bony fusion was evidenced in all cases.The final Frankel scale was Frankel A in 10 cases,Frankel B in 1 case,and Frankel D in 1 case.Conclusion：For acute upper-middle thoracic fracture complicated with severe overlapping dislocation,early sequential distraction and reduction by pedicle screws is feasible and effective.