摘要
目的 探讨胸腰椎Chance骨折的损伤机制、合并伤及短节段椎弓根螺钉系统治疗的疗效。方法 回顾性分析21例Chance骨折患者的临床资料，其中男18例，女3例；年龄16～56岁，平均31岁。重物砸伤9例，高处坠落伤7例，交通伤5例。Chance骨折发生在T11 1例，T12 3例，L1 9例，L2 6例，L3 1例，L2-3 1例。所有患者均无明显脊髓神经损伤。合并伤：高处坠落伤中1例合并踝关节开放脱位与颅脑损伤，1例合并跟骨骨折，另有1例合并T10压缩骨折；交通伤中1例合并肠系膜撕裂及脾破裂；重物砸伤中1例合并多根肋骨骨折，1例合并血气胸。所有患者行短节段椎弓根螺钉系统内固定治疗。结果 随访时间8个月～4．7年，平均3．1年，无并发症发生。伤椎前缘高度由术前（75．7±15．5）％恢复至术后（96．1±3．4）％（t=-6．61，P〈0．01），末次随访时为（94．8±3．4）％，与术后相比差异无统计学意义（t=1．98，P〉0．05）。Cobb角由术前（10．71±8．51）。恢复至术后（-1．1±9．7）。（t=4．80，P〈0．01），末次随访时为（-0．7±10．9）°，与术后相比差异无统计学意义（t=0．61，P〉0．05）。随访时患者Oswestry功能障碍指数平均为9．5（0～35）。结论 胸腰椎Chance骨折损伤机制较为复杂，不只是发生在系有安全带的交通伤中。不同的致伤因素引起的合并伤也不相同。Chance骨折是一种不稳定性脊柱骨折，短节段椎弓根螺钉系统治疗可重建脊柱的稳定性，恢复脊柱序列，获得较好疗效。
Objective To explore the mechanism of thoracolumbar Chance fracture, its spectrum of associated injuries and clinical efficacy of short segmental pedicle instrumentation. Methods From January 2001 to June 2006, 21 patients （ 18 males and 3 females, with age range 16-56 years, average 31 years） with Chance fractures were treated with short segmental pedicle instrumentation. The clinical data of these patients and relative literatures were reviewed. There were 9 patients with strike injuries （ 1 with multiple rib fracture and 1 with hemopneumothorax）, 7 with fall injuries （ 1 with open ankle dislocation and craniocerebral injury, 1 with calcaneus fracture and 1 with compression fracture of T10 ） and 5 with traffic injuries （ 1 associated with mesenterium laceration and splenic rupture） ： There were 1 patient with T11 fracture, 3 with T12 fracture, 9 with L1 fracture, 6 with L2 fracture, 1 with L3 fracture and 1 with L2-3 fracture. No patient had nerve lesion. Results All patients were followed up for average 3.1 years （ raning from 8 months to 4.7 years）, which showed no operation complications. The anterior vertebral height of the fractured vertebra was restored from （75.7 ± 15.5 ）% to （96.1 ± 3.4）% postoperatively with a significant statistical difference （ t = 4.8, P 〈 0.01 ）, and to （ 94.8 ±3.4） % during follow-up, with no significant statistical difference from the postoperative value （ t = 1.98, P 〉 0.05 ）. The Cobb＇s angle was restored from 10.7°±8.5° to -1.1° ±9.7° （t =4.8, P〈0.01）, and to -0.7° ＋ 10.9°during follow-up （t =0.61, P〉 0.05）. The mean Oswestry Disability Index was 9.5 （0-35）. Conclusions The injury mechanism of thoracolumbar Chance fracture may be complicated. It does not occur only in traffic accidents with seatbelt. Meanwhile, the associated injuries differ because of various causes. Short segmental pedicle instru- mentation can rebuild spinal stabilization and restore spinal alignment so as to achieve satisfactory therapeutic effect in treatment of thoracolumbar Chance fracture.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2007年第10期737-740,共4页
Chinese Journal of Trauma
