胸腰椎陈旧骨折手术原因分析

目的：分析胸腰椎陈旧骨折手术原因，为骨折的治疗提供借鉴。方法：根据62例胸腰椎陈旧性骨折病人的临床和影像学资料，回顾性分析其手术原因。结果：手术的主要原因为神经受压、局部不稳定、后凸畸形。造成这些原因的主要因素为：(1)早期对不稳定骨折未进行处理；(2)未对受压神经结构的骨性或间盘组织减压或减压不彻底；(3)错误地采用单纯椎板切除术；(4)内固定物选择不当或内固定不牢固；(5)植骨不充分或未植骨；(6)固定节段错误。结论：如胸腰椎骨折早期治疗得当，陈旧骨折手术是可以避免的。后期如有明确手术适应证应进一步治疗。

Analyzing the factors on surgery for old thoracolumbar fractures

Objective:Analyzing the factors on surgery for old thoracolumbar fractures,and providing clinical data for the early and late management for the thoracolumbar fractures.Method:62patients treated surgically for old thoracolumbar fractures were studied retrospectively with emphasis on the causes for operation.The mean duration of32(3~84)months from the injury to operation time.There were21type A injury,39type B injury and2type C injury according to the AO thoracolumbar fracture classification.22patients had grade A injury,12patients had grade B injury,17patients had grade C injury and11patients had grade D injury ac-cording to the Frankel classification.Result:The major causes for operation were neuro-structure compression,segmental instability and post-trauma kyphosis.The factors that lead to those pathological causes were(1)un-treated unstable fracture,(2)insufficient decompression or no decompression to neuro-strctures,(3)laminectomy on-ly,(4)bad internal fixation,(5)insufficient bone grafting or no bone grafting,(6)operated to wrong segment.Conclu-sion:These factors can be single or combined and can be avoided at the early stage of the treatment.Surgery is necessary for those who still has significant neurological deficit and severe local pain