脊柱胸腰段不稳定骨折的手术治疗

Internal fixation with spinal instrumentation for the management of unstable thoracolumbar fractures

探讨脊柱胸腰段不稳定骨折的手术治疗效果，并比较不同种类后路内固定方法的优缺点．方法：临床收治脊柱胸腰椎骨折患者256例，均采用后路内固定手术，包括Harrington棒、Edwards装置、改良Edwards系统、Dick钉和RF5种内固定装置，比较手术前后骨折复位（包括畸形角、矢状面位移、伤椎高度）以及神经功能恢复情况．结果：后凸畸形角由术前268”矫正到术后5．2”，矢状面位移由术前的29．9％纠正到术后的3．l％，压缩椎体高度由术前的53．2％恢复到术后的941％．不完全截瘫组术后神经功能有Frankell级以上改善的为gO．7％．在矫正后凸畸形角和恢复椎体高度方面以RF为最优；在纠正矢状面位移上以改良Edwards系统为最优．结论：开放复位后路内固定是治疗胸腰椎不稳定骨折的有效方法；内固定选择以RF为代表的经推弓根内固定较为理想．

AIM: To eva1uate the efficacy of instrumentationin the management of thoracolumbar fractures- METHODS:Between January 1984 and December 1998, 256 consecutivepatients, who suffered from unstable thoraco1umbar frac-tures, were' treated surgically with spinal instrumentation,including Harrington device, Edwards system, modified Ed-wards system, Dick device and RF system and follow-up was' conducted, averaging 3O months. RESULTS: Kyphotic de-formity was corrected from 26. 8' preoperatively to 5. 2' post-operatively, translation was reduced from 29. 9% to 3. 1 %and the height of compressed vertebral bodies was restoredfrom 53. 2% to 94. 1% of the normal height. Neurologicfunction of 9O- 7% cases improved above Frankel grade one.Of the five devices, RF got the most satisfactory results incorrecting kyphotic deformity and modified Edwards systemin the correction of translation. CONCLUSION: Internal fix-ation with spinal instrumentation is an effective method forthe management of unstable thoracolumbar fractures.