无脊髓损伤胸腰椎骨折脱位治疗原则与手术方法的研究

The Research of Treatment Principles and Surgical Methods of Thoracic and Lumbar Fractures Dislocation without Spinal Cord Injury

目的探讨无脊髓损伤胸腰椎骨折脱位的治疗原则与手术方法。方法自2008年1月-2011年1月，对12例无脊髓损伤胸腰椎骨折脱位的患者，11例在后路长节段椎弓根螺钉固定融合术的基础上应用术中跨责任椎单侧钉棒预置脊髓保护技术＋伤椎置钉及经椎弓根植骨技术＋责任椎置钉阶梯减压复位技术，1例患者因骨折脱位严重，术前评估复位困难，术中行椎管减压后原位融合内固定，经过6—30个月（平均19．6个月）的随访，随访内容包括术后、术后3个月、6个月．12个月对腰痛VAS评分、神经功能障碍情况（Fankel分级）、胸椎稳定性和影像学检查，影像学检查包括x线、CT,在侧位x线片上测量伤椎复位情况及椎体前缘高度。

Objective To explore the principles of treatment and surgical methods of research for thoracic and lumbar fractures dislocation without spinal cord injury. Methods From January of 2008 to January of 2011 , 12 patients with thoracic and lumbar fractures dislocation without spinal cord injury were treated. Eleven patients were treated with long-segment pedicle screw fixation and fusion with the techniques of spinal eord protection by prepositioning inter- nal fixation unilaterally ＋ the fractured vertebral set screws and transpedicular bone grafting ＋ the fractured vertebral set screws ladder decompression and reduction, 1 patient was treated with spinal canal decompression in situ fusion and internal fixation due to fracture dislocation severe and preoperative assessment reduction difficult. After 6 - 30 months （ mean 19.6 months） follow-up, included low back pain VAS score, neurological dysfunction situation （ Fankel grading） and imaging examination of 3 months,6 months, 12months after surgery. Imaging examination, including X-ray, CT. The reduction of fractured vertebral body, the leading edge of the vertebral body heigilt, kyphosis （ Cobb angle） and the status of the internal fixation were measured in the lateral X-ray,bone graft healing was assessed in CT. Results All patientswere followed up, postoperative VAS score of 0 scale （ 9 patients ）, 1 scale （ 2 patient ）, 2 scale （ 1 patient）, neurological function without injury. X-ray examination indicated the fractured vertebral body restored completely except 1 case which in situ fusion and internal fixation, the anterior vertebral height restoration to normal 94.3 %, Cobb angle of 5 o. The follow-ups of vertebral height and Cobb angle remained well without internal fixation breaking loose and prolapse. All 11 patients were bone healing. Conclusion For thoracic and lumbar fracture and dislocation without spinal cord injury, we must develop appropriate surgical options according to individual circumstances. The long-segment pedicle screw fixation and fusion with the techniques of spinal cord protection by prepositioning internal fixation unilaterally ＋ the fractured vertebral set screws and transpedicular bone grafting ＋ the fractured vertebral set screws ladder decompression and re- duction is an effective method to treat thoracic and lumbar three-column fractures dislocation without spinal cord injury. For the patients who are difficult to reset and easy to injure spinal cord and adjacent important tissue, we can choose in situ fusion and internal fixation.