单纯后路减压融合固定治疗完全性胸椎骨折脱位的疗效评价

Effects of simple posterior decompression and fusion fixation as treatment strategy for complete thoracic fracture dislocation

目的探讨后路减压椎弓根螺钉系统固定治疗完全性胸椎骨折脱位的临床疗效。方法采用回顾性病例系列研究分析2002年9月～2016年6月收治的6例完全性胸椎骨折脱位患者临床资料，其中男5例，女1例；年龄21～67岁，平均47．2岁。损伤节段：T3-4 1例，T5-6 2例，T6-7 2例，T8-9 1例。按美国脊髓损伤协会（ASIA）分级：E级1例，A级5例。均伴有多发肋骨骨折、血气胸。伴胸骨骨折1例，寰枢椎复合骨折1例，肺挫伤3例。采取后正中切口入路减压、椎弓根螺钉系统固定，复位后椎间植骨。记录手术时间、术中出血量。观察骨折复位、植骨融合、内固定失败及并发症等情况。比较术前及末次随访时视觉模拟评分（VAS）和ASIA分级，评价疼痛和神经功能改善情况。结果手术时间150～240min，平均205min。术中出血量700～2100ml，平均1167ml。术后1周因肺部感染死亡1例，其余5例均获随访3～14个月，平均7．4个月。术后5例复位满意，1例侧方移位部分复位。5例椎间植骨均获骨性融合，未出现内固定失败情况。术前VAS为（7．4±0．6）分，术后1周和末次随访时分别为（4．5±1．6）分、（1．8±0．3）分，与术前比较差异有统计学意义（P均〈0．05）。1例ASIA分级为E级患者术后无加重，4例ASIA分级无改善。结论单纯后路减压椎弓根螺钉系统固定可达到骨折脱位复位和骨性融合，为脊柱提供可靠的稳定性，还可减轻疼痛，是治疗完全性胸椎骨折脱位的理想选择。

Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation. Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study. There were five males and one female, aged 21-67 years old （mean, 47.2 years）. The injury segments were T3-4 dislocation in one case, T5 -6 dislocation in two cases, T6-7 dislocation in two cases and T8-9 dislocation in one case. There was one case of ASIA grade E and five cases of Grade A, and all of six cases were associated with multiple rib fractures and hemopneumothorax. The companied status was one case of sternal fracture, one case of atlantoaxial complex fractures and three cases of pulmonary contusion. The posterior median incision decompression and pedicle screw system fixation were performed, and the intervertebral bone grafting was conducted after restoration. The surgery time, bleeding volume during surgery, fracture restoration, bone grafting fusion, failure of internal fixation and other complications were recorded. The Visual Analogue Scale （VAS） and American Spinal Injury Association （ASIA） classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit. Results The surgery time was 150-240 minutes （mean, 205 minutes）. The bleeding volume during the surgery was 700-2 100 ml （mean, 1167 ml）. One case was died of pulmonary infection at one week after surgery, the others were followed up for 3-14 months （ mean, 7.4 months）. After operation, five patients were satisfied with the reduction, and the lateral displacement was partially restored in one cases. Five cases of intervertebral bone grafting all had bone fusion. There was no fixation failure. The VAS was （7.4 ± 0.6） points before surgery, （4.5 ± 1.6） points at one week after surgery and （ 1.8± 0. 3） points at final visit of follow-up, which had significant difference from the preoperative status （ P 〈 0.05）. One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement. Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion, provide stability for spine and relieve pain.