胸腰椎骨折脱位伤椎固定的可行性研究

目的探讨后路手术治疗合并前、后纵韧带断裂及椎间盘破裂的胸腰椎脊柱骨折脱位的疗效。方法2001年1月至2004年5月收治18例合并前、后纵韧带断裂及椎间盘破裂的脊柱骨折脱位患者，均为男性，年龄19-58岁，平均38岁，均合并截瘫。受伤节段为T11-L3。侧位X线片示骨折椎体楔形变，其中6例椎体后缘高度有丢失。骨折椎体高度压缩程度为1／4～3／4，上位椎体向前脱位25％～100％，2例合并侧方脱位。均于伤后10d内行后路减压椎弓根螺钉植入复位固定融合术。8例采用目前国内通用的在骨折椎体相邻上下椎体植入四枚椎弓根螺钉的复位固定技术，10例采用在骨折椎和相邻上下椎植入六枚椎弓根螺钉的复位固定技术。结果全部病例随访3个月-3年，平均18个月。8例采用二椎体四枚椎弓根螺钉植入者术后骨折椎体高度无改变5例，部分改善3例；骨折椎上位相邻椎脱位部分纠正6例，无变化1例，加重1例。1例出现撑开过度，1例术后3个月出现螺钉松动拔出，1例术后6个月出现断棒。10例三椎体六枚椎弓根螺钉植入者术后骨折椎体复位达80％～100％，骨折椎上位相邻椎脱位均完全复位。术后近期内无严重并发症。结论应用三椎体六枚椎弓根螺钉植入复位固定治疗合并前、后纵韧带断裂及椎间盘破裂的脊柱骨折脱位在操作技术上是可行的，对恢复椎体高度和纠正脱位有效。

Posterior operation for thoracolumbar spinal fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture

Objective To explore surgical treatment through posterior approach to reduce the fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine. Methods Eighteen cases suffered from the fracture and dislocation complicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine between January 2001 and May 2004, retrospectively were reviewed all the patients are male, aged from 19 to 58 years old (average 38 years). All the patients are paraplegia. The involved vertebrae are T11 to L 3. All the lateral X-ray films showed the fractured vertebra taking on wedged shape. The posterior vertebral body-height was decreased in six patients. The fractured vertebra lost its height by 1/4 to 3/4 of normal height. The upper vertebral dislocation extent was from 25% to 100%. Two cases complicated with lateral displacement. All the patients were operated on within posttraumatic 10 days. One of the two posterior surgical techniques was used for a given patient: 1) One technique is implantation of pedicle-screws in upper and lower vertebrae just adjacent to fractured vertebra. 2) Another technique is implantation of pedicle-screws both in fractured vertebra and its adjacent upper and lower vertebrae. Results All the patients were followed up 3 months to 3 years (average 18 months). 8 cases were treated with two-vertebrae 4 pedicle-screws implantation technique, the height of fractured vertebral body was not improved in 5 cases, partially improved in 3 cases. The dislocation of the upper vertebra adjacent to fractured vertebra was partially improved in 6 case, not changed in 1 case, got worse in 1 case. 10 cases were treated with three-vertebrae 6 pedicle-screws implantation technique, the height of fractured vertebral body was all improved by 80% to 100%. The dislocation of the upper vertebra was corrected completely in all the ten cases. Conclusion The procedure of three-vertebrae 6 pedicle-screws implantation is practical, effective and useful for treatment of the fracture and dislocation comlicated with longitudinal ligaments and intervertebral disc rupture in the thoracic or lumbar spine.