骨折块急性侵入椎管程度与脊髓损伤的相关研究

Study of relationship between spinal cord injury and acute bone fragment compression

目的研究骨折块自椎体向背侧急性侵入椎管时，骨折块侵入程度与脊髓运动神经功能损伤的相关关系。方法以Wistar大白鼠为实验动物，取自体尾椎骨为致压物，显露胸段脊髓，将骨块迅速嵌入椎管，不同高度骨块对脊髓产生不同程度急性压迫，观察骨块侵入深度与脊髓损伤的相关关系。结果当骨折块自腹侧侵入椎管深度不及椎管矢状径23％时不造成明显的脊髓运动神经功能损伤;当侵入深度为椎管矢状径26％～40％时，出现明显的脊髓运动神经功能损伤，但所造成的神经功能缺失可完全恢复;当骨块侵入深度达椎管矢状径46％～66％时，所造成的运动神经功能缺失仅能部分恢复;当侵入深度达椎管矢状径73％以上时，出现脊髓运动神经完全性损伤，所造成的运动缺失观察8wk无任何恢复。结论脊髓运动神经与骨块急性压迫之间至少表现为4种关系:①脊髓运动神经对轻微骨块压迫表现为耐受。②中度骨块急性压迫（侵入深度达椎管矢状径1／5～2／5）对脊髓仅造成完全可逆性损伤。③较重的骨块压迫（侵入深度达椎管矢状径2／5～3／5）对脊髓运动神经造成不完全可逆性损伤。④严重的骨块压迫（侵入深度达椎管矢状径4／5以上时），对脊髓运动神经造成完全性不可逆损伤。

Objective Exploration of relationship between spinal cord injury and invasion depth of bone fragments into spinal canal. Methods Thoracic spinal cord of wistar rats was exposed and autogrous bone fragemts from tail vertebrate were pushed between spinal cord and verterbrate. Relationships between spinal cord injury and acute compression of fragments were observated. Results When the invasion depth of fragments was less than 23% of sagittal diameter of spinal canal, the compression did not injure spinal cord. When the invasion depth of fragment reached 26% -40% of sagittal diameter of spinal canal, motor neurologic deficit of spinal cord occured and would recovery completely in 8 weeks after foe trauma. When the invasion depth of fragments reached 46% - 66% of spinal canal sagittal diameter The neurologic deficit of spinal cord was severe and only recovered partialy. When the invasion depth of fragments was more than 73% of sagittal diameter of spinal canal. the damage of motor fiber of spinal cord was complete and was almost no recoverable Conclusion ①Bone fragments which project into spinal canal less than 23% of sagittal diameter of spinal canal should not cause spinal cord injury. ②bone fragments projecting into spinal canal 26% - 40% of sagittal diameter of spinal canal only cause light-moderate spinal cord injury and the neuologic deficit may recovery completely. ③Bone fragments projecting into spinal canal 46 % - 66 % of sagittal diameter of spinal canal should cause severe spinal cord injury and the neurologic deficit only recover partialy.④Bone fragments projecting spinal canal more than 73% of sagittal diameter of spinal canal should result in complete spinal cord injury and the neurologic deficit should be no recoverable.