胸椎骨折合并胸骨骨折的治疗

目的 探讨胸椎骨折合并胸骨骨折的损伤特点及治疗.方法 1996年5月至2007年11月,治疗胸椎骨折合并胸骨骨折患者21例,男15例,女6例;年龄17～65岁,平均35.4岁.受伤至就诊时间为1～24 h.致伤原因:交通事故伤14例,高处坠落伤5例,钝器伤2例.21例患者均合并多发创伤或骨折,其中胸椎压缩型骨折11例,骨折脱位7例,爆裂型骨折2例,屈曲牵张型骨折1例.完全性神经损伤6例,不完全性神经损伤4例,无神经损伤11例.非手术治疗6例,手术治疗15例.结果 21例患者均获得随访,随访时间8～99个月,平均37.7个月.术后6例完全性神经损伤患者神经功能无明显改善;1例无神经损伤患者出现迟发性神经功能障碍,余10例病情无加重,其中4例仍有胸背局部疼痛;4例不完全性神经损伤患者中1例恢复正常,1例有改善,2例无改善.结论 胸椎骨折合并胸骨骨折的临床特点为致伤暴力大,脊髓损伤严重,合并多发伤的概率高.早期固定胸骨有助于加强胸椎的稳定性,延缓胸椎后凸畸形的进展.

Treatment of thoracic fractures associated with sternum fracture

Objective To analyze the characteristics and treatment of thoracic fractures associated with sternum fracture. Methods From May 1996 to November 2007, 21 patients with thoracic fractures as-sociated with sternum fracture were retrospectively reviewed. Fifteen patients were male, and six patients were female, with a mean age of 35.4 years (ranged 17-65 years). Mechanism of injury: traffic accident in 14 cases, fall injury in 5 and blunt instrument injury in 2. All cases were associated with other injuries. There were 11 compressed fractures, 7 fracture-dislocations, 2 burst fractures and 1 seat-belt type fracture. Six pa-tients had a complete lesion of the spinal cord, four neurologically incomplete injury, and 11 neurologically intact. Six patients were treated nonoperatively and 15 underwent surgery. The intimate information of pa-tients were analyzed such as age, gender, cause of injury, site of the sternal fracture, level and type of tho-racic vertebral fracture, spinal cord injury and associated injuries. Results All patients were followed up for 8-99 months(mean 37.7 months). There was no significant improvement in 6 patients with complete para-lytic lesion. Among 11 neurologically intact patients, 4 had local pain although 10 of them remained normal function. And 1 patient tumed up tardive paralysis. One of 4 patients with incomplete paraplegia returned to normal, 1 recovered partially and 2 did not change. Conclusion The sternum is one of the important parts in constructing thoracic cage, the thoracic cage plays an important role in maintaining the stabilization of the thoracic vertebra. Thoracic fractures associated with the sternum fracture was marked by violent force, severe fractures of the spine, severe injuries of the spinal cord and high incidence of associated injuries. Early fixa-tion of the sternum helps to strengthen the stability of the thoracic spine and slow the progress of thoracic kyphosis.