合并椎体爆裂型骨折的颈椎过伸性损伤及其外科治疗

目的 探讨合并椎体爆裂型骨折的颈椎过伸性损伤的临床表现及治疗方法。方法 对1996～2004年间收治的17例合并椎体爆裂型骨折的颈椎过伸性损伤患者损伤原因、机制，合并脊髓神经损伤的类型、程度以及手术治疗疗效进行分析。结果 合并椎体爆裂型骨折的颈椎过伸性损伤常因高速撞击伤所致，损伤过程中发生了过伸性损伤转变为屈曲损伤，脊髓损伤严重。积极地行椎体切除减压、植骨融合重建颈椎稳定性的手术治疗效果满意。结论 合并椎体爆裂型骨折的颈椎过伸性损伤是由于过伸应力转变为屈曲应力。及早解除机械性压迫因素，重建和保持颈椎稳定性是手术治疗的原则。     

后路经椎弓根内固定治疗胸腰椎骨折

目的总结后路经椎弓根固定治疗胸腰椎骨折的治疗经验，评估其临床疗效。方法采用后路经椎弓根固定治疗胸腰椎骨折68例，按McAfee分类，楔形压缩骨折16例，稳定爆裂骨折24例，不稳定爆裂骨折20例，Chance骨折1例，屈曲牵拉型损伤3例，平移型损伤2例，T7平移型损伤合并T12压缩骨折1例，T10屈曲牵拉型损伤合并L4压缩骨折1例。术前术后X线片、CT片测量椎体高度恢复率、椎管横切面积、TSA角及SSA角，按Frankel评分评价手术效果。结果平均手术时间约97min，平均术中出血量约450ml。随访时间2～22个月，平均12个月。Frankel评分A级18例中2例术后上升1级，其余无恢复，B～D级22例均有1～2级上升。螺钉植入椎弓根位置的优良率为83．77％，椎体压缩高度恢复优良率为92．86％；椎体后凸角(Cobb法)及椎管横切面积复原满意。6枚椎弓根螺钉折断，21枚弯曲，1例连杆折断，6例后期发现Cobb角有平均5。再损失。结论应用后路经椎弓根固定治疗胸腰椎骨折可以获得满意的治疗效果。     

脊柱骨折应用DR检查与多层螺旋CT诊断对比研究

目的 DR检查与多层螺旋CT在脊柱骨折诊断中的临床应用。方法 将2019年6月至2021年6月期间，本院收治的68例脊柱骨折患者纳入研究，入选患者均接受DR和多层螺旋CT两种检查方式，记录其在各种类型中的诊断准确率。结果 DR检查中诊断屈曲压缩型骨折30例、爆裂型8例、安全带型11例和骨折脱位型10例；MSCT检查中诊断屈曲压缩型骨折31例、爆裂型10例、安全带型14例和骨折脱位型13例，二者在屈曲压缩型脊柱骨折中无显著差异（P>0.05），在爆裂型、安全带型和骨折脱位型脊柱骨折中均有显著差异（P<0.05）;DR检查中诊断椎管狭窄13例、脊柱曲度改变19例、椎管内骨碎片9例和椎体楔形变36处；MSCT检查中诊断椎管狭窄19例、脊柱曲度改变25例、椎管内骨碎片12例和椎体楔形变41例，二者在各项解剖学结构改变统计中均有显著差异（P<0.05）。结论 MSCT在脊柱骨折诊断中具有较高的准确率，对不同类型的脊柱骨折有良好的区分度，为脊柱骨折的诊断和治疗提供有力线索。     

Wiltse入路治疗胸腰椎骨折的疗效分析

目的 探讨经Wiltse入路复位内固定治疗胸腰椎骨折的临床疗效.方法 2008年1月～2010年1月,本院手术治疗胸腰椎骨折患者32例,男17例,女15例;年龄为18～63岁,平均年龄43岁.手术治疗病例均为Denis分型为压缩型骨折、爆裂型骨折和屈曲过伸骨折且不需后路减压的患者.其中T12椎体骨折10例,L1椎体骨...     

颈髓完全性损伤治疗方法的选择

报告了４２例颈髓完全性损伤非手术治疗的结果。平均年龄２９．７岁。骨折分类：屈曲型２５例，压缩型１０例，过伸型７例。损伤椎节为Ｃ_４～Ｃ_７，平均观察时间为７．８个月。按Ｆｒａｎｋｅｌ分级，仅有４例（９．５％）进步到Ｂ级；按胥少汀对完全性颈髓损伤的修正疗效标准，神经功能改善率为５２．３％。损伤当时截瘫平面高于或等于骨折节段者有较好的恢复率，而低于者无恢复。分析对比了文献报道的早期手术治疗结果，认为：颈髓完全性损伤早期手术与非手术治疗结果无明显差异。强调对完全性损伤早期判断的重要性，建议制定统一的疗效评定标准，并就相关问题进行了讨论。     

前路与后路减压内固定治疗胸腰椎爆裂型骨折的比较

胸腰椎爆裂型骨折（T10～L2），一般是由于屈曲压缩暴力引起，致残率较高，多需外科手术治疗，手术治疗本身也存在一定的难度和风险。笔者自2001～2005年，分别应用前路减压内固定技术与后路环状减压内固定技术治疗胸腰椎爆裂型骨折79例。现对2种不同手术方式的特点、应用指征及临床疗效进行对比。     

可吸收球囊椎体成形术治疗胸腰椎爆裂骨折的实验研究

[目的]探讨结合短节段椎弓根螺钉系统撑开复位内固定的可吸收球囊椎体成形术治疗胸腰椎爆裂骨折的生物力学性能变化。[方法]采集6具新鲜固定湿润成人尸体胸腰椎标本，制成T11-L1，L2～4、L1～3节段标本10个，用自由落体撞击试验造成中间椎体爆裂型骨折，行APF椎弓根螺钉撑开复位，经椎弓根于伤椎椎体内置入可吸收高分子材料-DL-乳酸与ε-己内酯（70：30）的共聚物（PDLLA-CL）制作的可吸收球囊，注入自固化磷酸钙骨水泥行可吸收球囊椎体成形术。分别于骨折前、骨折撑开复位椎体成形术后，用万能材料试验机测定中间椎体在前屈、后伸、侧屈状态下应力-应变、轴向刚度变化及扭转应力下刚度的变化。[结果]伤椎经可吸收球囊椎体成形术治疗后，抗压强度均有所增加，前屈为8％，后伸15％，侧屈9．8％，其中以后伸时增加显著（P〈0．05）。治疗后的轴向刚度普遍得到提高，与骨折前相比，前屈增加11％，后伸增加8％，侧屈增加3％。治疗后椎体在扭转应力下刚度小于骨折前，但两者差异不明显（P〉0．05）。[结论]（1）结合短节段椎弓根螺钉系统撑开复位内固定的可吸收球囊椎体成形术，有助于伤椎的重建，术后脊柱的生物力学特性接近骨折前水平；（2）可吸收球囊椎体成形术治疗胸腰椎爆裂骨折，在避免骨水泥渗漏可能导致的潜在危险之前提下，从本质上恢复胸腰椎爆裂型骨折伤椎椎体结构的完整性，恢复其高度，从而恢复和维持脊柱的生理弧度，防止继发性脊柱后凸畸形变引起的迟发性腰背痛及脊髓、神经损伤，以从根本上解决单纯用经椎弓根内固定器治疗胸腰椎爆裂型骨折遗留的并发症，为临床治疗胸腰椎爆裂骨折提供了一个新的方法。     

小儿脊柱爆裂型骨折

目的：探讨小儿脊拄爆裂型骨折的特性、诊断与治疗、并比较与成人同类骨折的不同特点。资料与方法：1974～1994年间收治的小儿创伤性、闭合性脊柱损伤中，有11例诊为爆裂型骨折。平均年龄为144岁，男5例，女6例。平均随访时间为9年(2～16年)。按照Denis爆裂型骨折分类法，4例为A型；6例为B型；1例为C型。根据伤后的严重程度，6例行后路融合和器械固定，5例卧位．石膏和支具治疗。结果：随访发现90％患儿有满意的功能结果。伤后及随访时的X线摄片评价表明手术治疗能够改进和维持骨折部位的后凸畸形(伤后平均19°．随访时12°)，椎体前侧压缩改进15％(伤后平均39％，随访时24％)。而非手术治疗的后凸畸形平均进展9°（伤后平均15°，随访时为24°)，椎体前侧压缩进展8％(伤后平均36％．随访44％），3例合并有神经系统症状患儿，2例有明显改进。结论：1．由于小儿脊柱的解剖特点，爆裂型骨折的诊断与治疗有其特性。2、与成人同类骨折相比，骨折的稳定性较好，神经系统症状轻。3、手术治疗可稳定骨折，并防止后凸畸形和椎体前侧压缩的进一步发展，减步住院或卧床时间。4、非手术治疗对无神经系统症状的稳定骨折是有效治疗手段，但在伤后1年中，后凸畸形和椎体前侧压缩有轻度、渐进性的发展趋势。     

颈椎骨折脱位合并瘫痪32例

在工农业生产 ,交通运输业中发生颈椎骨折 ,或骨折脱位合并脊髓损伤瘫痪病人中占一定比例。对这部分病人的处理 ,目前仍有很大争议 ,尤其对晚期脊髓损伤。我们对早期颈椎骨折或骨折脱位合并脊髓损伤瘫痪 32例病人 ,根据损伤程度不同 ,临床体征不一 ,采取不同治疗方法 ,现报告如下。1　临床资料本组 32例中 ,男 30例 ;女 2例。年龄 7～ 5 5岁 ,平均 36岁。颈椎骨折 6例 ,颈椎骨折脱位 18例 ,单纯颈椎脱位 8例。屈曲型损伤 30例其中椎体压缩粉碎性骨折 ,或椎体粉碎型骨折 2 4例。过伸型损伤 2例 ,均为椎体脱位合并椎体、椎板骨折。损伤部位以…     

胸腰段脊柱爆裂型骨折机理及实验模型

目的：建立Ｌ１单椎体爆裂型骨折模型，探讨胸腰段脊柱爆裂型骨折机理及损伤后三维运动的变化情况。方法：收集７例新鲜成人Ｔ８～Ｌ５节段胸腰椎标本，在脊柱三维运动试验机上测试正常标本Ｔ１２～Ｌ１及Ｌ１～Ｌ２节段的三维运动范围。然后施以５００Ｊ的能量撞击，撞击后拍摄Ｘ线正侧位片，并重复测试损伤后标本的三维运动范围。结果：７例标本的Ｌ１均产生爆裂型骨折。在Ｔ１２～Ｌ１节段和Ｌ１～Ｌ２节段标本在前屈、后伸、左右侧弯和左右轴向旋转方向的运动范围和中性区均有显著性增大（Ｐ＜０．０１）。结论：我们所建立的单椎体爆裂型骨折模型为脊柱的实验研究提供了一个较为理想的方法。在胸腰椎爆裂型骨折中，脊柱在各个方向上的运动范围均有显著的急性不稳定性     

Fractures of the Cervical Spine in Patients with Ankylosing Spondylitis

Fractures of the cervical spine in six patients suffering from ankylosing spondylitis are presented. Three patients had a hyperextension type of injury. These fractures were extremely unstable and combined with spinal cord damage. in the other cases the fracture was caused by a flexion mechanism. These fractures were stable and there was no damage to the spinal cord. Treatment modified according to the demands of the fractures is outlined.     

Fractures of the Cervical Spine in Patients with Ankylosing Spondylitis

Fractures of the cervical spine in six patients suffering from ankylosing spondylitis are presented. Three patients had a hyperextension type of injury. These fractures were extremely unstable and combined with spinal cord damage. in the other cases the fracture was caused by a flexion mechanism. These fractures were stable and there was no damage to the spinal cord. Treatment modified according to the demands of the fractures is outlined.     

Anterior fusion for rotationally unstable cervical spine fractures

STUDY DESIGN: A retrospective analysis of 32 rotationally unstable cervical fractures treated by brace, halo vest, or posterior surgical constructs plus fusion is compared with a second, prospective study of 18 similar fractures treated by early anterior discectomy, fusion, and plating. OBJECTIVES: To characterize an often unrecognized fracture pattern and compare various methods of management to identify the most effective treatment. SUMMARY OF BACKGROUND DATA: The rotationally unstable cervical spine fracture (compression-extension Stage 1) involves a hyperextension and lateral flexion injury, resulting in a unilateral pedicle, facet complex, and/or lamina fracture under compression and anterior annular disruption under tension. This fracture pattern allows a rotatory spondylolisthesis of the spine around the axis of the intact lateral mass and facet complex. METHODS: A retrospective review was made of 284 cervical fractures, identifying 32 compression-extension Stage 1 fractures that were treated by a variety of techniques. The results of that study led to a second (prospective) study, in which 18 similar fractures were treated by early anterior discectomy, fusion, and plating. RESULTS: Nonoperative treatment was uniformly unsuccessful. Posterior stabilization and fusion procedures led to unsuccessful results in 45%, related either to late kyphosis because of disc collapse or the inability of midline stabilization procedures to control rotational instability. Anterior fusion resulted in solid union without residual deformity in all cases. All four patients in the prospective study with incomplete cord lesions showed improvement in cord function, as did seven patients who had radiculopathy. CONCLUSION: Although posterior bony injury is the usual radiographic finding, the anterior disc and anterior longitudinal ligament disruption are the more significant injuries and lead to late collapse and kyphotic deformity. Early anterior fusion is recommended in compression- extension Stage 1 cervical spine injuries.     

Traumatic spondylolisthesis of the axis.

The lesions of C2 seen in hyperextension injuries of the cervical spine following motor vehicle accidents, diving accidents, and headlong falls resemble the cervical lesion found in judicial hangings. Although the mechanism of injury in these cervical fractures is different, the distinction is significant. The fracture seen in motor vehicular accidents today usually seems to be one of hyperextension and axial compression rather than hyperextension and distraction. This distinction is responsible for the low incidence of neurologic involvement seen in the fracture caused by motor vehicle accidents. The incidence of face and scalp injuries associated with axis pedicle fractures appears significant. Union of this fracture can generally be expected, and it rarely produces late sequelae. Management of this fracture is generally preferable on an ambulatory basis utilizing a cervicothoracic brace or a halo and caudal support in more unstable fractures. A period of 12 weeks of immobilization is recommended for satisfactory union of this fracture. Occasionally the treatment of this fracture may require traction or operative intervention. If operative intervention is required, an anterior route employing interbody fusion is suggested.     

Thoracic spine fractures

Fractures of the thoracic spine (T2-T12) should be considered as a separate entity because of the anatomic features of the rib cage and spinal canal in this region. Fifty-seven patients sustained this injury over a 10-year period (16% of thoracic, thoracolumbar, and lumbar fractures). Twenty-eight fracture dislocations, 25 compression fractures, and 1 burst fracture were seen. Three injuries, combining elements of a burst fracture and a dislocation, were designated "burst-dislocations." Apart from compression fractures, a direct blow was often the implicated mechanism of injury. Significant associated injuries were uncommon. Fracture-dislocations were often associated with neurologic injury and compression fractures with long-term pain. Operative treatment appeared to afford the best results for stabilization and pain relief.     

Fractures of the sternum

Although rare, fractures of the sternum probably occur more often than is realized or discovered. They are not diagnosed because serious complicating injuries often accompany them and because they are difficult to depict with the roentgen rays. Anatomically the manubrium is rigidly attached to the vertebral column through fusion with the first pair of ribs. Elsewhere the attachments are more elastic and resistant to fracture.Fractures of the sternum are produced by direct blows, falls, or crushing injuries. They generally occur in the upper portion of the bone where there is rigid attachment to the axial skeleton. Displacement of fragments is unusual and the ligamentous coverings prevent lacerations of nearby structures. These fractures are diagnosed by deformity, sharply localized pain, crepitation and immobility of the thorax in respiration. Specialized roentgen-ray technique will reveal the detail of the bone, and should be utilized when there is distinct suspicion of fracture in this portion of the thorax.This type of injury is best treated by rest in bed, local heat and moderate hyperextension. Recovery is prompt and complete, and there is seldom any indication to recommend radical therapeutic measures.Only 8 cases have been observed in The Mayo Clinic, and 4 of these were seen in the first eight months of 1932.     

The pathological anatomy of fatal atlanto-occipital dislocations.

Nine atlanto-occipital dislocations were found in postmortem examinations of 112 victims of multiple trauma. Axial traction facilitated roentgenographic identification of the injury. A hyperextension mechanism of injury was suggested by the associated injuries, including submental lacerations and mandibular fractures. Atlanto-occipital dislocations were more frequent in children than in adults. A pure dislocation injury without fracture was identified.     

Fractures of the sesamoid bones of the thumb

Sesamoid fractures of the metacarpophalangeal joint of the thumb may be classified into two types: (1) with palmar plate intact, and (2) with palmar plate ruptured. In type 1, the patient maintains a normal flexion posture of the metacarpophalangeal joint as well as the ability to flex the metacarpophalangeal joint and interphalangeal joint. In type 2, the metacarpophalangeal joint assumes a hyperextension posture and the patient is unable to flex the metacarpophalangeal joint. Three cases are described to illustrate the two types of the injury. An open fracture of a thumb sesamoid associated with laceration of the palmar plate in a child was treated by reapproximating the palmar plate and the fracture fragments with sutures. Two additional closed fractures of the thumb sesamoid were treated by splinting the metacarpophalangeal joint in comfortable flexion for 2 to 3 weeks. Normal hand function was restored in all the three patients.     

Angiographic detection of carotid and vertebral arterial injury in the high-energy blunt trauma patient

BACKGROUND AND OBJECTIVE: Injury to the carotid and vertebral arteries is an identified risk to patients after blunt high-energy cranio-cervical trauma with an associated risk of thromboembolic stroke. We sought to determine the incidence, features, and risk factors of arterial injury using selective cerebral angiography in a high-risk trauma patient subset. METHODS: Blunt trauma patients with a high-energy mechanism were selected to undergo screening cerebral angiography if they met one of the following criteria: (1) cervical spine hyperextension/hyperflexion injury, (2) skull-base or facial fracture, (3) lateralizing neurologic deficit, ischemic deficit, or cerebral infarction, or (4) hemorrhage of arterial origin. RESULTS: Of 69 screened patients 20 were found to have a vascular injury (28.9%), including 13 carotid and 15 vertebral; 9 of the 20 patients with vascular injury were symptomatic (45%). The most frequent injuries were intimal dissections (8/28), pseudoaneurysms (6/28), and vessel occlusions (5/28); 8 lesions were intracranial and 20 cervical. Displaced facial fractures (P<0.02) but not skull-base fracture were predictive of carotid injury; multilevel cervical spine fractures (P<0.001) and transverse foraminal fractures (P<0.02) were associated with vertebral injury. CONCLUSIONS: Cerebral angiography in a selected group of trauma patients was found to yield a significant rate of carotid and vertebral arterial injury, a finding that had implications to subsequent clinical management.