摘要
目的： 探讨胸腰段脊柱骨折合并脊髓损伤早期行后路减压、适宜内固定的临床疗效.方法： 回顾分析我院2000年2月～2008年9月收治的59例胸腰段脊柱骨折并脊髓损伤伤后24h内釆用后路减压适宜内固定患者临床资料,其中高处坠落伤32例,砸压伤11例,车祸伤16例;损伤椎体：T113例, T1223例,L127例,L24例,T12L1双椎体2例.结果： 59例中49例获得连续随访,随访时间：5个月～4年.椎体形态的恢复Cobb＇s角由术前平均26.2°（11～47°）恢复到术后平均3.4°（0～9°）;椎体前缘高度由术前平均52%（14%～71%）恢复到术后89.1%（85%～100%）.神经功能恢复：按Frankel分级49例较术前平均提高1～3级,2例出现较术前一过性加重.结论：胸腰段脊柱骨折合并截瘫者宜早期手术治疗,及早解除脊髓压迫,并选用恰当的椎体内固定和植骨以稳定脊椎柱,是脊髓损伤恢复的有效措施.
Objective To approach the clinical effect of early operations with posterior decompression and suitable internal fixation to the fracture of thoracic and lumbar spine complicated with cord injures. Method Reviewed the 59 cases of fracture in thoracic and lumbar spine complicated with cord injures from February 2000 to September 2008, which were operated with posterior decompression and suitable internal fixation in 24 hours after injured. 32 cases were fall from higher place, 11 cases were crashed by heavy things, traffics accident were 16 cases. The injured level were T113 cases, T1223 cases, L127 cases, L24 cases, T12 and Lldouble segments 2 cases. Result 49 patients in those 59 cases were followed up from 5 months to 4 years. The Cobb＇s angle of spine was increased from 26.2 degree （11 to 47 degree ） pro - operation to 3.4 degree （ 0 to 9 degree ） post - operation. The height of anterior border of vertebral was recovered from 52% （ 14% to 71% ） pro- operation to 89.1% （ 85% to 100% ） post - operation. The function of nerve recovery scored by Frankel was raised 1 to 3 stage, 2 eases were worse temporally. Conclusion The fracture of thoracic and lumbar spine complicated with cord injures should be operated early to depress the compression of spinal cord and choice a suitable internal fixation and bone graft to stable the spine, it is a effective therapy to the recovery of cord injures.
关键词
胸腰段脊柱骨折
脊髓损伤
后入路椎管减压
后路内固定
Fracture of thoracic and lumbar spine
cord injures
posterior decompression
internal fixation
