中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗

Surgical Treatment of Middle-super Thoracic Spinal Fracture and Dislocation Combined with Incomplete Spinal Cord Injury

目的探讨中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗方法及疗效。方法 2006年4月至2010年3月,采用后路减压植骨融合长节段椎弓根钉内固定治疗中上胸椎骨折脱位合并脊髓不完全性损伤患者15例,观察术前、术后随访的X线及CT片,比较伤椎的Cobb角、椎体高度和神经损伤的变化情况。结果 15例患者均获12～48个月(平均26.5个月)随访,切口均一期愈合,骨折愈合时间:6～14个月(平均9.5个月)。术后并发症:肺部感染1例,深静脉血栓l例,均经处理后痊愈,无内固定失效发生。术前和术后在伤椎的Cobb角、椎体高度丢失方面进行比较,差异有统计学意义(P<0.05)。术后神经损伤按照ASIA分级:B级2例改善为C级,1例改善为D级;C级5例改善为D级,2例改善为E级;D级3例均改善为E级,无加重患者。结论中上胸椎骨折脱位合并脊髓不完全性损伤采用后路减压植骨融合长节段椎弓根钉内固定治疗可获得满意疗效,把握手术时机以及术中仔细操作是成功的关键。

Objective To explore the effects of surgical treatment of middle-super thoracic spinal fracture and dislocation combined with incomplete spinal cord injury.Methods 15 patients with middle-super thoracic spinal fracture and dislocation combined with incomplete spinal cord injury were treated with posterior pedicle screw fixation,reduction and fusion from April 2006 to March 2010.X-ray and CT films of preoperative and postoperative follow-up were observed,the vertebral Cobb angle,vertebral height and changes of nerve injury were compared.Results 15 patients were followed up for 12～48 months with an average of 26.5 months,the incision were primary healing,the healing time of fracture was 6～14 months with an average of 9.5 months.Postoperative complications：1 case with lung infection,1 case with deep vein thrombosis,all patients were cured after treatment,no fixation failure occurred.Preoperative and postoperative vertebral Cobb angle and vertebral height loss were compared,the difference was statistically significant（P0.05）.The postoperative nerve injury was graded according to ASIA,2 cases in ASIA B improved to ASIA C,1 case in ASIA B improved to ASIA D;5 cases in ASIA C improved to ASIA D,2 cases in ASIA C improved to ASIA E;all the 3 cases in ASIA D improved to ASIA E,there were no patients with disease exacerbation.Conclusion Decompression and fusion with posterior long segment pedicle screw fixation for the treatment of middle-super thoracic spinal fracture and dislocation combined with incomplete spinal cord injury can obtain satisfactory therapeutic effects,grasping the timing of surgery and carefully operating during operation is the key to success.