后路手术治疗中上胸椎骨折脱位

Treatment of upper-middle thoracic fracture and dislocation with posterior approach

目的 探讨后路减压内固定治疗中上胸椎骨折脱位的方法及效果.方法 2002年9月至2007年9月采用后路手术治疗中上胸椎骨折脱位21例.其中压缩性骨折5例,爆破型骨折4例,骨折脱位12例 完全性瘫痪12例,不完全性瘫痪9例.本组减压复位后均采用椎弓根螺钉系统固定,骨折块突入椎管者,行侧后方骨折块复位或摘除减压.观察患者手术时间、出血量,测量手术前后胸椎滑移程度及椎间隙夹角.以Frankel评分系统评价神经功能.结果 本组患者随访0.5～5.0（2.5±0.5）年.术前Frankel评分（1.0±0.1）分,术后（1.3±0.1）分 其中不完全性瘫痪者术前评分（2.2±0.2）分,术后（3.1±0.2）分.术后椎间隙高度、椎间隙夹角及滑移百分比较术前改善（P＜0.05）.内植物无松脱或移位.结论 中上胸椎骨折脱位脊髓损伤程度重,预后差.不稳定性骨折应及时行融合及内固定术,合并有不完全性脊髓损伤者应同时行减压手术.早期后路手术,患者能获得满意的复位和即刻稳定性,脊髓功能获不同程度改善.

Objective To assess the clinical effect and methods of posterior decompress and fixation for upper-middle thoracic fracture and dislocation. Methods Between September 2002 and September 2007,21 patients suffered from upper-middle thoracic fracture and dislocation were treated with posterior approach, which comprising 5 patients with compressed fracture,4 patients with burst fracture, 12 patients with fracture and dislocation. There were 12 cases companied by complete paraplegia, and 9 cases companied by incomplete paraplegia. All cases adapted to pedicle screw fixation system after decompression and reduction. Reduction or removal of fragments was done through posterior-lateral of the spinal canal for patients with fragments migrated into the spinal canal. The operation time,blood loss volume,preand postoperative transverse displacement degree and angle of the injured vertebra were recorded. The neurological function was assessed by Frankel criteria. Results The patients was followed up for （2.5 ± 0.5 ） years. The Frankel score increased from （ 1.0 ± 0.1 ） scores preoperatively to （ 1.3 ± 0.1 ） scores postoperatively. The incomplete paraplegia patients＇ score increased from （2.2 ± 0.2） scores preoperatively to （3.1± 0.2） scores postoperatively. The height of injured vertebral body, the interangle of vertebral body and spondylolistheses after operation increased comparing with those before operation（P 〈 0.05 ）. No implant loosening or breakage was found. Conclusions Severe spinal cord injury occurs in upper-middle thoracic fracture and dislocation.Unstable fracture should be treated with internal fixation and fusion in time. Decompression ought to be done in patients who suffering from incomplete paraplegia. Early operation takes advantages of immediate stability and a good improvement of the neurologic function.