多节段脊柱损伤128例分析

An analysis of 128 cases of multi-segmental spinal injuries

目的 提出一种多节段脊柱损伤的分类方法 ,以提高诊断意识与治疗水平。方法 对 12 8例多节段脊柱损伤进行回顾性分析 ,平均随访 8 2年。按自行设计的分类方法进行分类。结果 相邻型 82例 (占 6 4 1% ) ,非相邻型 4 6例 (占 35 9% ) ;损伤部位以胸腰段为主 ;脊髓功能 :FrankelA级 6 0例 ,B级 12例 ,C、D级 2 7例 ,E级 2 9例。手术治疗 6 9例 (其中减压内固定 4 2例 ) ,保守治疗 5 9例。随访 94例 ,改善 1级者 30例 ,改善 2级者 2 9例 ,无改善者 35例。结论 类型不同其患病率、致伤因素、脊髓损伤严重度及诊断失误率均不同 ,诊断必须正确 。

Objective To develop a new classification of multi segmental spinal injuries to enhance the diagnostic recognition and improve the outcome. Methods 128 cases of spinal injuries were reviewed retrospectively, which had been followed up for average 8 2 years, and had been classified by self designed classification of functional spinal unit (FSU). Results According to the new classification, 82 cases (64 1%) were contiguous spinal injuries and 46 cases (35 9%) were non contiguous injuries. The injuries mostly occured at the thoracolumbar level. According to Frankel's grade, the spinal cord function belonged grade A in 60 cases, B in 12 cases, C、 D in 27 cases, and E in 29 cases. 69 cases were treated with surgery, of which 42 cases were undergone internal fixation with decompression. 59 cases were treated nonoperatively. 94 cases had been followed up. Recovery of cord function reached grade one in 30 cases, grade two in 29 cased. No improvement was found in 35 cases. Conclusion Different classifications usually have different morbidity, mechanism of injury and severity of spinal cord injury and rate of missed diagnosis. Therefore, accurate diagnosis is very important. A whole spine radiographic survey should be accomplished as requirment if necessary.