多节段非相邻型胸腰椎骨折的手术治疗及分型

目的：探讨多节段非相邻型胸腰椎骨折的手术治疗方式和分型。方法：2005年12月至2008年12月共治疗24例多节段非相邻型胸腰椎骨折患者,其中男16例,女8例;年龄18～63岁,平均36岁。根据ASIA脊髓神经功能损伤分级：A级1例,B级2例,C级2例,D级8例,E级11例。按改进的MNSF分类方法将骨折分为：A型15例,B型9例。骨折范围T6～L4,共累及48个椎体。按ASIA分级评分及影像学资料进行回顾性分析。结果：24例患者均接受手术治疗,无漏诊或延迟诊断。患者术后均获随访,随访时间3～36个月,平均18.3个月。骨折全部获得骨性愈合,骨折椎体高度无明显丢失,无钉棒弯曲、松动或断裂。术前13例脊髓神经损伤患者,术后除1例A级和1例B级无恢复外,其余11例均有1级以上脊髓神经功能恢复,共计A级1例,B级1例,C级1例,D级2例,E级19例。结论：对传统分类方法进行改进以便指导临床治疗,多节段非相邻型胸腰椎骨折的治疗方式应该根据神经损伤情况、骨折稳定性及骨折类型决定。

Surgical treatment and classification of multiple-level noncontignous thoracolumbar fractures

Objective: To explore the surgical treatment and classification of multiple-level noncontignous thoracolumbar fractures. Methods: From December 2005 to December 2008,24 patients with multiple-level noncontignous thoracolumbar fractures were treated by surgical operation included 16 males and and 8 females with a mean age of 36 years old ranging from 18 to 63 years. According to the ASIA grade of spinal nerve function there was 1 case in grade A,2 cases in grade B,2 cases in grade C,8 cases in grade D and 11 cases in grade E. Based on the modified classification of multiple-level noncontiguous spinal fractures(MNSF) there were 15 cases of type A,9 of type B. The fracture involved 48 vertebraes ranged from T6 to L4. Radiographic data were analyzed retrospectively. Results: All patients achieved surgical treatment without missed diagnosis or delayed diagnosis. All cases were followed up for from 3 to 36 months(means 18.3 months). All cases achieved bone fusion,without significantly lose of the vertebrae body height and implant failure. Among 13 patients with spinal nerves injuries before operation,11 got more than one grade improvement of the ASIA grading,2 remained unchanged. Conclusion: The traditional classification methods are improved to guide treatment. The treatment of multiple-level noncontignous thoracolumbar fractures should be determined according to the severity of spinal cord injury,the stability and the types of spine fractures.