182例下腰椎骨折特点的描述性分析

The characteristics of lower lumbar fractures:a descriptive analysis of 182 cases

[目的]通过描述性分析下腰椎(L3～5)骨折,探讨下腰椎骨折的流行病学特征及临床特点。[方法]回顾性分析本院松江新院2006年9月1日～2010年6月30日所有下腰椎骨折患者的性别、年龄、骨折原因、合并伤等资料,对单节段骨折按照AO分型系统分型,多节段骨折按照唐三元等的MSF分类法分型,同时参照AO分型系统对胸腰椎每一个骨折节段分型。[结果]共获取182例下段腰椎椎体骨折患者,男98例,女84例,性别比(男:女)1.2,平均年龄(50.6±19.7)岁。患者年龄分别与性别比、骨折原因呈线性相关。共累及L3椎体116个、L4椎体74个、L5椎体22个。单节段骨折102例(56.0%),多节段骨折80例(44.0%),后者在非创伤性骨折多见。创伤性骨折共132例,男性的风险为女性的3.95倍,患者的平均年龄显著低于非创伤性者。骨折主要由压缩暴力引起,其中A型骨折136个(93.2%),C1型6个(4.1%),各节段骨折类型没有明显差异。多节段创伤性脊柱骨折共50例(37.9%),Ⅰ型21例(42.0%),Ⅱ型29例(58.0%)。合并胸腰段(T11～L2)骨折者共41例(31.1%),T10以上脊柱骨折8例(6.1%)。56例(42.4%)合并其他部位合并伤,最多见者为四肢骨折(41例,31.1%),其次为胸外伤(25例,18.9%)。[结论]下腰椎骨折因其解剖和生物力学特点,多为压缩暴力引起,多节段骨折多见,创伤性下腰椎骨折年轻男性多见,较多合并胸腰段骨折和其他部位损伤。

[Objective]To descriptively analyze the epidemical and clinical characteristics of lower lumbar（L3 to L5） fractures. [Method]We analyzed the sex,age,causes,associated injuries,and other information of all the lower lumbar fracture cases treated from Sep.1st,2006 to Jun.30th,2010 in Songjiang Division of our hospital,retrospectively.All the single-level fractures were classified by the AO-classification system,whereas the Tang Sanyuan＇s classification for all the multiple-level spinal fractures,and each level was classified according to the AO-classification system. [Result]Totally we obtained 182 cases of lower lumbar vertebral factures.There were 98 males and 84 females.The ratio of sex（male：female） was 1.2.The average age was 50.6±19.7 years old.There was a linear correlation between age and the ratio of sex and the cause of fracture.One hundred and sixteen fractures of L3 vertebrae,74 of L4 and 22 of L5 were involved.There were 102 cases（56.0%） of single-level fractures and 80 cases（44.0%） of multiple-level fractures,and the latter was more common in non-traumatic ones.One hundred and thirty-two cases of traumatic lower lumbar fractures had a significant lower average age compared with non-traumatic cases.The risk in the males was 3.95 times greater than the females.Axial compressive violence was the main cause of the fractures,among which there were 136 levels（93.2%） of type-A and 6 levels（4.1%） of type-C1.No obvious difference was found between each level.There were 50 cases（37.9%） of traumatic multiple-level spinal fractures,21（42.0%） of type-I and 29（58.0%） of type-II.Forty-one cases（31.1%） were complicated with thoracolumbar（T11-L1） fractures,8（6.1%） with level above T10.Fifty-six cases（42.4%） were associated with injuries in other sites,of which the most commonly seen were limbs fractures（41 cases,31.1%）,followed by thoracic injuries（25 cases,18.9%）. [Conclusion]The characteristics of epidemiology and classification of lower lumbar fractures should be given serious attention in clinical practice.