上胸椎骨折脱位

Fracture and dislocation of upper thoracic spine

目的 探讨上胸椎骨折脱位的特点及治疗。方法 17例上胸椎骨折脱位患者 ,压缩骨折 5例 ,骨折脱位 7例 ,爆裂骨折 3例 ,爆裂骨折伴脱位 2例。完全瘫痪 10例 ,不完全瘫痪 7例。根据上胸椎骨折的类型以及脊髓受压的程度 ,采用前路和后路手术方法。T1,2 骨折 6例 ,采用前路手术经胸锁关节或切除锁骨段。切除骨折椎体后采用自体骨块或钛质网笼与自体骨植入 ,自锁钢板固定。其余 11例行后路手术。完成减压复位后采用椎弓根钉或钩棒系统进行固定。结果 随访 2～ 7年。完全瘫痪的 10例中有 2例改善 ,不完全瘫痪的 7例中有 6例改善。结论 上胸椎骨折脱位损伤重 ,预后差 ,应根据骨折的类型和脊髓受压的程度及时减压和固定。

Objective To study the characteristics of fracture and dislocation of upper thoracic spine and the related treatments. Methods 17 patients with upper thoracic fracture and dislocation (5 with compressed fracture, 8 with fracture-dislocation, 3 with burst fracture and 2 with burst-dislocation) were retrospectively evaluated. Among them, 10 patients had a complete paralysis, while the other 7 had an incomplete paralysis. Anterior or posterior surgeries were operated to the patients according to the fracture types and the degree of compression of spinal cord. 6 cases with T_1 or T_2 fracture and dislocation were conducted cervicothoracic incision or resection of the interior part of clavicle that is close to sternoclavicular joint for the removing of fractured vertebra, decompression, intervertebral fusion and fixation. The decompressive procedure was followed by the replacement of a strut using an allograft bone or titanium net and the implanting of an anterior locking plate. Posterior surgeries were undergone for the other 11 cases. The decompression and reposition were performed after the internal fixation using pedicle screws or hook-rod system.Results All patients were followed up from 2 to 7 years after the operations. 2 of the 10 patients with complete paralysis got functional improvements. 6 of the 7 patients with incomplete paralysis gained some recovery of the function.Conclusion Fracture and dislocation of upper thoracic spine were severe injuries with bad prognosis. It is recommended to undergo decompression and internal fixation timely for upper thoracic spine according to the types of fracture and the degree of compression of spinal cord.