胸腰椎屈曲牵张型骨折的诊断与手术治疗策略

目的探讨胸腰椎屈曲牵张型骨折的诊断和手术治疗方法。方法22例胸腰椎屈曲牵张型骨折,均为男性,年龄为21~56岁,平均34.8岁。损伤节段:T128例,L18例,L25例,L31例。神经功能Frankel A级3例,B级1例,C级2例,D级6例,E级10例。骨折按Denis分型,A型9例,B型1例,C型11例,D型1例。行短节段椎弓根螺钉复位内固定治疗,术中根据骨折情况个体化运用撑开与压缩技术。随访时间为10~47个月,平均29个月。结果1例因操作方法不当而复位不良,其余21例术后畸形矫正满意,后凸畸形完全恢复。除Frankel A级3例神经功能无明显恢复外,其余神经损伤者均获得了不同程度神经功能的改善。结论个体化灵活运用椎弓根螺钉的撑开与压缩技术治疗胸腰椎屈曲牵张型骨折,效果满意。

Diagnosis and surgery strategy of the flexion-distraction injuries in the thoracolumbar spine

Objective To discuss the diagnosis and surgery treatment of the flexion-distraction injuries in the thoracolumbar spine. Methods Twenty-two cases of the flexion-distraction injuries in the thoracolumbar spine were included in this group (male all, age range 21-56 years, mean 34.8 years). The injured segments included 8 T12, 8 L1, 5 L2 and 1 L3. According to Frankel classification: there were 3 cases of grade A, 1 case of grade B, 2 cases of grade C, 6 cases of grade D and 10 cases of grade E. Based on Denis classification, there were 9 cases of flexion-distraction injuries type A, 1 case of type B, 11 cases of type C and 1 case of type D. Open reduction and fixation with short-segmental pedicle screw instrumentation were performed, while individualized distraction and compression were applied according to the injuries during the operations. The follow-up times were 10-47 months, with a mean of 29 months. Results Twenty-one cases kyphosis deformity were corrected satisfactorily, and one case remained kyphotic due to incorrect manipulation. Except for 3 cases graded Frankel A preoperatively, the other patients with neurological deficit had different improvement in neurological function. Conclusion Individua-lized distraction and compression techniques with pedicle screw instrumentation is effective for thoracolumbar flexion-distraction injuries.