胸腰椎Chance骨折21例临床分析

目的：探讨胸腰椎Chance骨折的创伤机制、-临床特点和诊治方法。方法：本组21例患者，男13例，女8例；年龄23～57岁，平均32岁。骨折部位：T11 3例，T12 29例，L1 8例，k1例。骨折按Denis分类：A型10例，B型2例，C型5例，D型4例。神经功能ASIA分级：A级0例。B级1例，C级2例，D级2例，E级16例。本组均行经椎弓根内固定治疗，并行脊柱后外侧植骨。结果：21例平均随访18个月（13～28个月）。除1例ASIAB级术后神经功能无改善外，其余ASIAC级或D级者恢复至E级。术后X线片示骨折复位及内固定满意，未出现内固定松动或断裂。术后腰背疼痛及功能情况总体满意。结论：胸腰椎Chance骨折属于屈曲牵张性损伤，发病率低，神经症状少，为不稳定骨折，采用经椎弓根内固定治疗此类骨折可获得满意疗效。

Clinical study thoracolumbar Chance fractures:a report of 21 cases

Objective: To discuss the mechanism,clinical characteristics,diagnosis and treatment of thoracolumbar Chance fractures. Methods: Among all the 21 patients,13 patients were male and 8 patients were female, ranging in age from 23 to 57 years,with an average of 32 years. The injury was at the level of T₁₁ in 3 patients,at the level of T₁₂ in 9 patients,at the level of L₁ in 8 patients and at the level of L₂ in 1 patient. According to Denis classification,10 patients were type A,2 type B, 5 type C,and 4 type D. All the patients were treated with pedicle screw internal fixation and posterior lateral fusion at the level of injury. Results: Twenty-one patients had been followed up for an average of 18 months(13 to 28 months). According to ASIA neurologic grading system,4 cases in grade C or D recovered to grade E postoperatively and one case in grade B was not improved. Postoperative X-ray showed good reduction and fixation in all cases and no looseness or breakage in the fixation system. The results of postoperative back pain and function assessment were mostly satisfactory. Conclusion: Thoracolumbar Chance fractures are due to flexion-distraction injuries and regarded as unstable,which are uncommon and usually not present with a neurologic deficit. Reduction and stabilization with posterior pedicle screw internal fixation is suggested in patients with thoracolumbar Chance fractures.