胸腰椎损伤诊疗的问题与思考

Diagnosis and treatment of thoracolumbar spine injury

胸腰椎(T_(10)~L_(2))损伤是最常见的脊柱损伤,因该区域为脊柱应力集中区和局部解剖结构的特殊性,使其更易发生损伤,一旦治疗不当,会增加发生脊柱畸形和脊髓损伤等并发症的可能。随着脊柱外科的不断发展,胸腰段损伤的诊疗策略也在不断进步,但仍存在较多争议。笔者对胸腰椎损伤的分型和脊髓损伤诊治中的关键问题进行了探讨,包括胸腰椎骨折的分型、胸腰椎损伤的分类、伤情评估、治疗策略、手术治疗(时机、入路、固定、融合)等。述评从基本理论出发,结合国内外前沿理论以及笔者的自身经验对相关问题进行分析,以供临床参考。

Thoracolumbar spine injury is the most common spinal injury.Due to the stress concentration area and the particularity anatomical structure of the spine,this area is prone to injury.Once improperly treated,it will increase the possibility of spinal deformity and spinal cord injury and other complications.With the development of spinal surgery,the diagnosis and treatment strategies of thoracolumbar injuries are progressing,but there are still many controversies.The author discusses the classification of thoracolumbar injury and the key issues in the diagnosis and treatment of spinal cord injuries,including the classification of thoracolumbar fractures,the classification of thoracolumbar injury,injury evaluation,treatment strategies,surgical treatment(timing,approach,fixation,fusion),etc.The review is based on the basic theory,combined with the domestic and foreign frontier theory and the autho r’s experience to analyze relevant issues for clinical reference.