Thoracic spine fractures

Fractures of the thoracic spine (T2-T12) should be considered as a separate entity because of the anatomic features of the rib cage and spinal canal in this region. Fifty-seven patients sustained this injury over a 10-year period (16% of thoracic, thoracolumbar, and lumbar fractures). Twenty-eight fracture dislocations, 25 compression fractures, and 1 burst fracture were seen. Three injuries, combining elements of a burst fracture and a dislocation, were designated "burst-dislocations." Apart from compression fractures, a direct blow was often the implicated mechanism of injury. Significant associated injuries were uncommon. Fracture-dislocations were often associated with neurologic injury and compression fractures with long-term pain. Operative treatment appeared to afford the best results for stabilization and pain relief.     

Thoracic spine fractures

Thoracic spine fractures have unique characteristics, and should be managed with specific criteria that are different from those used for thoracolumbar injuries. Fracture-dislocation injuries require high-energy injury, and should always be suspected in polytrauma patients with rib cage, sternum, cardiac, or pulmonary injuries. Although treatment is individualized, multisegmental posterior fixation sometimes combined with anterior decompression, is most commonly used. The authors review the current literature on this topic, and present their opinion on the management of such injuries.     

胸腰椎过伸骨折合并弥漫性特发性骨肥厚症的临床研究

目的分析合并弥漫性特发性骨肥厚症(DISH)胸腰椎过伸骨折的损伤机制、损伤特点,以指导治疗方案的选择。方法回顾性分析自2007-01—2015-12诊治的95例合并DISH胸腰椎过伸骨折,根据X线片、CT及MRI评估脊柱损伤类型:前柱经椎间盘损伤44例(46.3%),经骨损伤41例(43.2%),混合型损伤10例(10.5%)。所有患者均行脊柱后路切开复位椎弓根钉内固定手术治疗。结果术后3例出现切口愈合不良,给予换药、抗生素治疗后痊愈。术后X线片显示8枚椎弓根钉位置不佳。在治疗期间,4例出现贫血,5例出现全身炎症性反应综合征(SIRS),4例抗甲氧西林金黄色葡萄球菌感染(MRSA),5例肺或肾脏衰竭,2例肺部感染,1例泌尿系感染,1例出现褥疮。4例在创伤后3个月内死亡,死亡患者年龄75~88(81.7±4.1)岁。结论随着高龄人口及脊柱代谢疾病的增多,DISH患者中出现的胸腰椎过伸损伤也会随之增加。临床骨科医师要充分认识合并DISH胸腰椎过伸骨折的特点,以便制定较为合理的治疗方案。     

Sagittal fractures of the cervical spine

Two cases of sagittal fracture of cervical vertebral bodies have been studied. The findings indicate that the fractures were a consequence of forces directed forwards against the posterior surfaces of the vertebral bodies due to flattening of the vertebral rings in an anterior-posterior direction.     

Cervical spine fractures with major associated trauma

A detailed review of 88 consecutive patients placed in skeletal tong traction for cervical fractures by the University of Louisville Neurosurgical Service during a 5-year period from July 1, 1979, through June 30, 1984, was carried out. Of this group, 60% of the patients had a major associated injury consisting of major facial and skull fractures, cerebral contusions or intracerebral blood clots, cardiac or pulmonary contusions, major thoracic injuries including rib fractures and hemo- or pneumothoraces, intra-abdominal injuries, and major extremity fractures. An additional 24% of the patients had minor associated injuries, including facial or scalp lacerations, general body lacerations, or abrasions and cerebral concussions. Only 16% of patients with cervical fractures had no evidence of any other associated injury. Acute cervical spine fractures require prompt assessment and resuscitation by personnel from multiple specialties, usually available only in major trauma centers where experienced personnel capable of handling diverse injuries are always present.     

胸腰椎骨折伴脊髓神经损伤的治疗进展

<正>胸腰椎骨折是脊柱损伤中最常见的损伤类型,约占脊柱损伤的90%[1]。骨折主要发生在T11~L2水平,主要与此节段突然失去肋骨的支撑作用,脊椎屈伸活动范围增大有关[2]。严重的胸腰椎骨折往往伴有脊髓神经损伤,国外报道其发生率为15%~30%[3]。损伤多见于男性,不同的年龄阶段致伤因素略有差异,年轻患者多由高能量的创伤引起,如交通事故、坠落伤等;老年患者(尤其是已存在明显     

Mediastinal widening associated with fractures of the upper thoracic spine

Widening of the mediastinum, when seen on radiographs of the chest in victims of trauma, is usually attributed to injury to the aorta. An aortic injury, when not lethal, often causes paraparesis or paraplegia due to ischemia of the spinal cord. A fracture of the upper thoracic spine can produce similar clinical and radiographic findings. The cases of three patients who had those findings are presented; in all three, the differential diagnosis between the vascular and skeletal injuries was difficult. Fracture of the thoracic spine should be included in the differential diagnosis whenever mediastinal widening is seen on radiographs.     

Multiple noncontiguous spine fractures

The data from a prospective study of 508 spine injuries were reviewed to determine the incidence of multiple noncontiguous spine fractures. All patients were examined at admission and at 1 and 2 years postinjury. This series identified 77 (15.2%) multilevel fractures. Motor vehicle accidents were the primary cause of these fractures. The incidence of neurologic injury was not significantly different between multiple noncontiguous and single fractures. Failure to use seat belts and ejection from the vehicle were the main factors associated with multiple noncontiguous spine injuries. Seven major fracture patterns were identified, which accounted for 60% of these injuries. The prognosis for multilevel spine fractures was not significantly worse that that for single-level injuries.     

下腰椎骨折

目的 探讨下腰椎骨折的损伤特点及治疗。方法 对一组45例下腰椎骨折病例作回顾性分析,其中压缩性骨折24例,爆裂性骨折14例,屈曲分离性骨折3例,骨折脱位4例。完全性瘫痪3例,不完全性瘫痪9例,无神经损害33例。非手术治疗26例,手术治疗19例。结果 随访1～15年。神经功能改善程度优33例,良4例,可1例,无变化7例,非手术病例与手术病例神经功能改善程度无显著差异(P>0.05),但手术病例腰背疼痛程度明显低于非手术病例(P<0.05)。结论 由于解剖学和生物力学的特殊性,下腰椎骨折具有其相应的损伤特点。多数下腰椎压缩性骨折为稳定性骨折,可行非手术治疗。而对于爆裂性骨折及屈曲分离性骨折椎管狭窄及后凸畸形明显者以及骨折脱位则应行手术治疗。     

Split coronal fractures of the lumbar spine

The clinical and radiological results of 12 patients with a split coronal vertebral fracture were analysed with minimum follow-up of 24 months. All patients were treated operatively with an AO internal spinal fixator and transpedicular bone grafting. The operation was supplemented with posterior bone grafts in 4 patients. All fractures healed without marked deformity. There were no vertebral body pseudarthroses. There were no neurological or vascular injuries due to the placement of pedicle screws or to transpedicular bone grafting. 10 patients, had excellent or good results.     

Multiple noncontiguous fractures of the cervical spine

Multiple noncontiguous fracture-subluxations of the cervical spine are fractures and subluxations separated by at least one normal intervening cervical vertebra. A review of all 66 consecutive cervical spine fractures treated by the Division of Neurosurgery at the University of Ottawa during 26 consecutive months revealed six such cases (9%). These injuries are more common than previously recognized. Special consideration is required in their treatment because of the presence of a mobile intermediate segment in some of these patients.     

Multiple level noncontiguous fractures of the spine

From 1970 to 2000, 81 patients with noncontiguous fractures of the spine were evaluated. Of these 81 patients, 36 had a neurologic deficit. Sixty-six patients with stable injuries were treated conservatively, whereas 15 patients with unstable injuries required surgical stabilization. There was no neurologic deterioration either in the patients who had surgical stabilization or in the patients who were treated conservatively. Thirteen patients with an A score on the American Spinal Injury Association neurologic impairment scale did not improve and had a high mortality rate (61.5%). Although multiple level noncontiguous fractures of the spine are uncommon, they constitute a threat to neurologic function, and therefore warrant radiographic evaluation of the entire spine with multiple injuries.