严重胸椎骨折脱位的手术治疗

Surgical treatment of severe thoracic spine fracture and dislocation

目的 探讨严重胸椎骨折脱位的手术策略及方法。方法 严重胸椎骨折脱位 37例 ,采用侧前方减压植骨 12例 ;后路复位减压内固定 2 5例 :TSRH椎弓根镙钉固定 11例 ,Axis固定 6例 ,Har rington棒固定 8例。后路固定的同时行椎板切除 ,椎管环状减压。结果 X线复查骨折脱位情况 ,复位良好 30例 ,有 5例脱位由术前的Ⅲ度纠正至Ⅰ度 ,2例未复位。椎弓根钉位置不佳穿破皮质 2例 ,Harrington棒后期脱棒 1例。神经功能A级 2 1例 ,有 12例恢复至B级 ,2例恢复至C级 ,7例无恢复 ;B级 8例 ,有 5例达C级 ,3例达D级 ;C级 6例 ,有 4例达D级 ,2例接近E级 ;D级 2例均达E级。结论 彻底减压和重建脊柱的稳定性是手术治疗胸椎骨折并截瘫的主要目的。胸椎采用椎弓根螺钉内固定安全可行。采用后方入路减压内固定是较合理的选择。

Objective To explore the methods and strategies in the treatment of severe thoracic spine fracture and dislocation. Methods There were 37 cases of severe thoracic spine fracture and dislocation, of which 12 cases were treated with anterolateral decompression and bone graft fusion. 25 cases were treated through posterior approaches, of which 8 cases with Harrington rod, 11 with TSRH pedicle screws and 6 with Axis fixator. Laminectomy and circular decompression were performed with posterior fixation. Results The anatomic reduction of fracture and dislocation was nearly achieved in 30 cases on radiographs. 5 cases with dislocation Ⅲ degree in preoperation were corrected to Ⅰ degree. Fracture and dislocation was not corrected in 2 cases. Of the 17 cases with pedicle screws system, 2 were found to have penetrated the cortex of the pedicle. Of the 8 Harrington rod, 1 was found to have dislocation of hook and rod. Neurological function in all patients had improved to different degree except for frankle A grade. Conclusion Pedicle screw instrumentation of the thoracic spine is safe and feasible. The posterior approach is a rational choice for unstable fracture of the thoracic spine.