胸椎骨折合并胸骨骨折的治疗与分型

Treatment and classification of thoracic fracture accompanied with sternum fracture

目的:探讨胸椎骨折合并胸骨骨折的损伤特点、分型及治疗。方法:对32例胸椎骨折合并胸骨骨折的病例作回顾性分析。患者年龄、性别、受伤原因、胸骨骨折部位、胸椎损伤节段及类型、脊髓损伤程度及其他合并伤等资料均作为相关信息列入分析。其中压缩骨折13例,骨折脱位13例,爆裂骨折5例,爆裂脱位1例。完全性神经损伤6例,不完全性神经损伤13例,无神经损害13例。非手术治疗10例,手术治疗22例。根据相关治疗结果归纳总结分型方案。结果:随访10～103个月。损伤原因以交通伤和坠落伤为主,32例均合并多发创伤或多发骨折。6例完全性神经损伤病例病情均无改善;13例无神经损伤中有1例出现迟发性神经功能障碍,其余无病情加重,但其中5例仍有胸背局部疼痛;13例不完全性神经损伤中有3例神经功能恢复正常,5例有改善,5例无变化。结论:胸椎骨折伴胸骨骨折的临床特点为致伤暴力强大,脊柱骨折、脊髓损伤严重,多合并多发伤;新的分类方法更适用于胸椎骨折合并胸骨骨折,同时也进一步证实了胸椎第4柱的存在及其临床意义。

Objective To determine the characteristics,classification,and treatment of thoracic fracture accompanied with sternum fracture.Methods Data of 32 patients with thoracic fractures accompanied with sternum fracture were reviewed.Patients information such as age,gender,cause of injury,site of sternum fracture,level and type of thoracic vertebral fracture,spinal cord injury and associated injuries was included in the analysis.Of the 32 patients,13 had compressed fractures,13 had fracture-dislocations,5 had burst fracture and 1 had burst-dislocation.Six patients had a complete lesion of the spinal cord,13 sustained a neurologically incomplete injury,and the other 13 were neurologically intact.Ten patients were treated nonoperatively and the other 22 surgically.Results All patients were followed up for 10-103 months.Road traffic accidents and falling dominated among the causes.All patients were accompanied with other injuries.None of the 6 patients with a complete paralitic lesion regained any significant function.Of the 13 neurologically intact patients,5 had local pain although 12 of them remained normal function.One patient showed tardive paralysis.Three of the 13 patients with incomplete paraplegia returned to normal,5 regained some function and 5 did not recover.Conclusion Thoracic fractures accompanied with sternum fracture are marked by violent force,severe fracture of the spine,severe injuries of the spinal cord,and high incidence of other injuries.The new classification method is more suitable to thoracic fractures accompanied with sternum fracture,and confirms the existence and clinical relevance of the 4th column of the thoracic spine and its role in providing spinal stability in patients with thoracic fracture.