手术治疗胸腰椎结核合并后凸畸形

目的:探讨单切口双入路椎弓根系统内固定、后外侧植骨同期病灶清除、椎间植骨治疗胸腰椎结核合并后凸畸形的疗效。方法:对78例胸腰椎结核合并后凸畸形患者采用单切口双入路行后外侧植骨椎弓根系统内固定,同期病灶清除、椎间植骨治疗,观察患者症状及截瘫改善情况,后凸畸形矫正情况及植骨融合情况。结果:所有患者症状均明显改善,48例合并截瘫的患者中,25例完全恢复正常,7例ASIA分级改善1￣3级;植骨均在术后6个月￣1年融合,治愈率52.08%,好转率14.58%。后凸Cobb角平均矫正28.7°,随访1.4￣6.5年,平均2.6年,后凸角平均丢失2.9°。结论:单切口双入路后外侧椎弓根系统内固定同期病灶清除、椎间植骨可恢复脊柱的即刻稳定性,有利于植骨融合,后凸畸形矫正满意。     

Specific selection of osteosynthetic material in the treatment of thoracic or lumbar spinal injuries by the posterior approach

Summary The authors report 165 cases of thoraco-lumbar lesions with neurological dysfunction. All the patient were operated. They analyze the neurological and mechanical results and indicate the use of different osteosynthesis apparatus according to the type and level of lesions.Harrington's rods seem to give more precise repositioning while Roy Camille's plates give more stability. When the posterior wall of the spinal canal is intact, Kempf's compression rods can be used.Thoraxic spine injuries seem to be an indication for Harrington's rods, while lumbar injuries seem to call for Camille's plates.     

胸腰椎骨折脱位DRFS治疗

目的：总结DRFS在胸腰椎骨折脱位中的治疗体会。方法：对67例行DRFS内固定的胸腰椎骨折脱位病例术前、术后的X线片变化及其功能恢复情况进行观察和分析。结果：67例获得9-38个月的随访，术后伤椎的高度及脊柱Cobb角均有较满意的恢复，神经功能按Frankel分级有1-3级的改善，断钉1例，松动6例，已有11例取出内固定物，优良率为89.55%。结论：DRFS后路短节段经椎弓根内固定治疗胸腰椎骨折脱位，操作简单，易于安置，并能最大限度地恢复椎体及椎间隙的高度，为脊柱的结构重建和功能恢复提供了一个坚强而稳固的基础。     

胸腰椎骨折前路手术体会

目的 探讨胸腰椎骨折前路手术的方法和效果。方法 通过对19例胸腰椎骨折病人的前路减压植骨内固定术后的疗效分析。以说明前路手术的选择、适应症以及手术要领。结果 全部病人经过4-32月平均8个月随访,植骨全部融合,内固定系统无松动、断裂、脊髓神经功能有不同程度的恢复。结论 胸腰椎骨折前路手术减压彻底,固定牢固,恢复椎体高度,正确掌握前路手术适应症,疗效是肯定的。     

Thoracolumbar fracture dislocation (AO type C injury): A systematic review of surgical reduction techniques

Spinal injuries constitute about 3% of all injury cases and most of these injuries affect the thoracolumbar region, but thoracolumbar fracture-dislocations are much rarer. Dislocations (AO Type C injuries) of the thoracic and lumbar vertebrae, with or without associated fractures, happen due to very high energy trauma involving simultaneous, multidirectional, distractive and compressive forces across various spinal elements, which results in translational and rotational instability of the spinal column. Various reduction maneuvers have been described for thoracolumbar fracture-dislocations in the literature aiming to provide standardization in surgery for this situation. The aim of this review article is to systematically review the literature till date and describe various reduction maneuvers which help to achieve adequate sagittal and coronal balance as well as vertebral alignment with minimal soft tissue trauma. We searched the PubMed, the Cochrane Library (the most recent issue), Scopus, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, Web of Science, International Clinical Trials Registry Platform (WHO), ClinicalTrials.gov and Google Scholar databases, besides other sources and general internet search. The strategy used in the search was briefly(’‘thoracolumbar’’ OR ‘‘dorsolumbar’’) AND “dislocation” in PubMed. Similar searches were made in the other databases.Reference lists of the relevant papers were also examined and any further relevant studies, which were also included in the review.The initial search revealed 332 papers in Pubmed, out of which 302 were human studies. A similar search on Scopus revealed 528 documents and on WoS revealed 289 papers. Searching the Cochrane library revealed 9 trials, which were already revealed in Pubmed search results. All the references were imported into Endnote and we had 632 references after excluding duplicates and 126 papers were left in endnote after manual title screening and duplicate removal. Finally, 70 relevant papers were selected for consideration based on inclusion criteria, after excluding unrelated papers manually. We have summarised the published literature on the surgical management of thoraco-lumbar fracture dislocations and described the reduction maneuvers used in detail.     

改良Dick钉固定治疗胸腰椎骨折(附25例报告)

目的　总结改良Dick钉固定治疗胸腰椎骨折的临床经验。方法　对椎体后缘移位轻的骨块 ,不需要减压 ,对椎体后缘骨块移位较重或有椎板粉碎骨折 ,则半椎板切除或全椎板切除 ,充分减压 ,在C型臂透视下 ,用改良Dick钉固定。结果　术后伤口 2周拆线 ,Ⅰ期愈合 ,均复位固定良好 ,随访 6个月～ 3年 ,瘫痪康复按ASIA分级 :完全瘫痪 4例中 ,2例无变化 ,1例恢复至B级 ,1例提高至C级 ;不全瘫痪中全部恢复至E级。结论　此手术操作简便 ,安装快捷 ,固定可靠 ,是治疗胸腰椎骨折的有效方法。     

Percutaneous vertebroplasty for the treatment of osteoporotic burst fractures

Background  Vertebroplasty is a minimally invasive surgical procedure which involves injecting polymethylmethacrylate into the compressed vertebral body. At present the indications include the treatment of osteoporotic compression fractures, vertebral myeloma, and metastases. The value of vertebroplasty in osteoporotic compression fracture has been discussed comprehensively. The surgical operation for burst fractures without neurological deficit remains controversial. Some authors have asserted that vertebroplasty is contraindicated in patients with burst fracture. However, we performed the procedure, after considering the patents general condition, to reduce surgical risks and the duration of immobilisation. The purpose of this study is to investigate clinical outcomes, kyphosis correction, wedge angle, and height restoration of thoraco-lumbar osteoporotic burst fractures treated by percutaneous vertebroplasty. Materials and methods  Twenty-five patients with osteoporotic burst fracture were treated with postural reduction followed by vertebroplasty. We measured the kyphosis, wedge angle, spinal canal compromise and the height of the fractured vertebral body initially, after postural reduction, and after vertebroplasty. Findings  The average height of the collapsed vertebral bodies was 24.8% of the original height. Average kyphosis angle was 19.4° and average wedge angle was 19.8° at first. Mean canal encroachment was initially 25.1%. Kyphosis angle, wedge angle, and anterior, middle, and posterior height improved significantly after the procedure. The mean amelioration of the spinal canal encroachment after vertebroplasty was 23.3%. The average increase in anterior vertebral body height was 7.5 mm, central was 5.8 mm, and posterior was 0.9 mm. The mean reduction in kyphosis angle was 6.8° and the mean reduction in wedge angle was 9.7°. Conclusion  Although vertebroplasty has been considered as contraindicated in thoraco-lumbar burst fractures, we successfully used the procedure as a safe treatment in patients with osteoporotic burst fracture without neurologic deficit. This method could eliminate the need for and risks of major spinal surgery. We would like to offer it as a relatively safe and effective methods of management in thoraco-lumbar burst fractures.     

钛网支撑植骨融合加前路钉棒系统内固定治疗胸腰椎结核

目的探讨一期前路病灶清除钛网支撑植骨融合加内固定治疗胸腰椎结核的临床疗效。方法回顾性分析2001年2月至2008年3月在本院接受治疗的胸腰椎结核患者21例,男12例,女9例,年龄18～72岁,平均48.5岁。所有患者均采用一期前路病灶清除、钛网支撑植骨融合加前路内固定术,其间观察围手术期并发症,测定融合节段后突角度、椎间平均高度、钛网沉降率及植骨融合情况。结果全部病例随访20～48个月,平均26个月,除1例出现肋间神经痛,其余20例均无术后并发症。随访期间未发现结核病灶残留或复发,术后融合节段后凸角为（7.0±2.5）°,终末随访时矫正角度丢失（4.1±1.5）°,所有患者终末随访均达到骨性愈合。结论一期前路病灶清除钛网支撑植骨融合加内固定治疗胸腰椎结核的临床疗效显著,具有重建可靠,减压彻底和复发率低等优点。     

AF钉复位固定治疗胸腰椎爆裂性骨折

目的　评价AF椎弓根螺钉内固定系统治疗胸腰椎骨折的效果 ,探讨保留棘上韧带半环槽式减压符合生物力学和解剖学特性。方法　C臂X光机透视下按Weinstein解剖定位法拧入螺钉后固定。调整螺栓撑开角度。有全瘫者或CT示有大的骨块突入椎管压迫硬膜囊见椎管变窄大于 30 %者采用保留棘上韧带半环槽式开窗减压。结果　 17例患者椎体前缘高度由术前 55%恢复至术后 85% ,Cobb′s角由术前平均 19 4°恢复至术后 8 9°。椎管内移位骨块复位率达 93 5%。平均随诊 18 2月 ,恢复按ASIA分级 :A级中 2例 ,有 1例无变化 ,余 15例均提高 1～ 3级。结论　AF钉能达到精确复位固定及椎管有效减压 ,应用方便有效。棘上韧带保留半环槽式减压符合生物力学和解剖学特点。     

胸腰段脊柱骨折合并亚急性进行性上升性瘫痪(附9例报告)

目的：探讨胸腰段脊柱骨折后出现进行性瘫痪平面上升的原因。方法：回顾性分析1995年9月-2001年11月收治的385例胸腰段脊柱骨折患者中9例合并进行性瘫痪平面上升患者的临床特点、病程转归、手术探查所见及预后。结果：9例患者于受伤后24h。。72h瘫痪平面开始上升，持续进展l-2周后稳定于某一平面，上升到C5脊髓平面1例、C7 1例、T2 2例、T4 1例、T6-T7 1例、T7-T8 2例、T10 1例。9例均由不完全性瘫痪发展为完全性截瘫。二次手术探查时发现其肉眼病理变化为：脑脊液明显减少或消失，骨折平面以上的长段脊髓呈紫绀色缺血坏死状改变，脊髓萎陷变细，搏动消失。随访5个月-3年，1例随访5个月瘫痪无恢复，6例于伤后1-2．5年死于各种并发症，2例存活超过3年者瘫痪平面和程度无改善。结论：胸腰段脊柱骨折合并进行性瘫痪平面上升的发生率约2．3％，预后差，其发生的直接原因是上升性脊髓缺血性坏死所致。