胸椎骨折脱位伴脊髓神经损伤功能重建临床处理研究

Discussion on Internal Fixation for the Treatment of Thoracic Spine Fracture and Dislocation Combined with Spinal Cord Injury

目的:探讨胸椎骨折脱位伴脊髓损伤的不同节段内固定的方法,评价脊椎单元骨折重建与脊髓修复效果。方法:回顾性分析我院2005年1月～2010年12月收治的60例胸椎骨折伴脊髓损伤患者的临床资料。对胸椎中上段骨折采用多节段椎弓根螺钉内固定,对胸椎下段骨折行经伤椎置钉短节段椎弓根螺钉内固定。积极采用运动治疗、作业治疗及膀胱训练,观察伤椎椎体前高比和脊髓神经及肢体功能的恢复情况。结果:术后随访3月～5年,伤椎前高比明显高于术前(P<0.05);感觉运动评分较术前亦明显提高(P<0.05)。结论:选择恰当的椎弓根螺钉内固定能较好地重建骨折脊椎解剖结构、生物力学及椎管有效容积,为脊髓修复提供解剖基础,采用积极规范康复措施,能最大限度恢复脊髓神经功能。

Objective： To discuss the internal fixation method for thoracic spine fracture and dislocation combined with spinal cord injury,and evaluate the effect of restoration and reconstruction.Methods：The clinical information of 60 cases from Jun.2003 to Jun.2007 were retrospectively analyzed.The fracture in middle-up part was fixed by multi-segmental pedicle screw,while lower part was fixed by short-segmental pedicle screw.The affected vertebra height and recovery condition of spinal nerves were observed.Results：All the cases were followed up for 3 years after operation.The affected vertebra height was obviously higher than that before operation（P0.05）;and sensorimotor scores was also obviously imroved after operation（P0.05）.Conclusion：The proper pedicle screw for internal fixation can better rebuild fracture vertebral and restore nerve function.