胸腰椎骨折伴脊髓损伤治疗进展

脊柱骨折伴脊髓损伤的治疗，一直是脊柱外科关注的课题，随着对神经损伤的病理生理研究深入和手术方法的改进，对其治疗方法和观点也有了进一步的发展。本文就胸腰椎骨折伴脊髓损伤治疗方面的进展进行综述。     

经后路硬膜前方减压治疗胸腰椎骨折伴脊髓马尾神经损伤

经后路硬膜前方减压治疗胸腰椎骨折伴脊髓马尾神经损伤孙天全，刘志宏，张开欣，于学文，庄会文，王军良自１９９２年２月～１９９５年２月，我科采用经后路硬膜前方减压椎弓根内固定治疗胸腰椎骨折并脊髓马尾神经损伤３１例，取得良好效果。临床资料男１８例，女１３例。...     

无神经损伤的胸腰椎骨折的治疗进展

目前,对于无神经损伤的胸腰椎骨折患者,在手术适应证的确定、手术方法的选择等方面,一直存在着争议[1、2],一些学者倾向于保守治疗,但常因为后凸畸形的持续存在,到晚期引发代偿性劳损型疼痛,严重者可因椎管或椎间孔狭窄造成晚期脊髓或神经根受压,因此,手术治疗也是非常需要的。笔者就近年来无神经损伤的胸腰椎骨折的治疗新理念、观点以及治疗方法作一综述。     

胸腰椎骨折伴脊髓马尾损伤的治疗

胸腰椎骨折伴脊髓马尾损伤的治疗万年宇１宋展昭１自１９９３年１月至１９９５年１２月，我院共收治胸腰椎爆裂骨折７４例，现就治疗中的一些问题做一探讨。１一般资料男６２例，女１２例；年龄２２～４４岁，平均３１．３岁。致伤原因：摔伤４６例，砸伤１４例，撞伤１４...     

前路手术治疗胸腰椎骨折伴脊髓损伤

目的探讨前路减压内固定术对胸腰椎骨折伴脊髓损伤的应用价值。方法胸腰椎骨折伴脊髓损伤患者56例,均行经前路减压内固定术。其中单节段受累50例：T10 1例、T11 2例、T12 17例、L1 19例、L2 9例、L3 2例;双节段受累6例：T12和L1 5例、T11和T12 1例。Frankel分级：A级11例,B级23例,C级15例,D级5例,E级2例。结果所有病例脊髓均获有效减压,平均随访18个月,植骨融合良好,无脊柱后凸畸形及内固定断裂或松动等并发症。伤椎高度由术前（1．5±0．2）cm恢复到（2．9±0．3）cm,后凸Cobb角由术前25°±3°恢复到5°±2°。Frankel分级：A级3例,B级8例,C级20例,D级16例,E级9例。结论前路减压内固定术是集直视下直接减压、复位、内固定、植骨融合、畸形矫正、重建脊柱稳定一次性完成的有效方法。     

AF系统治疗胸腰椎骨折伴脊髓损伤

自从Rey—Calmille提出椎弓根系统以来,后路短节段椎弓根螺钉内固定系统逐渐完善。AF系统具有复位满意、手术创伤小、操作简便、内固定牢固并允许患者早期下床活动等优点,近年来在临床广泛应用于胸腰椎骨折的内固定。自1999年1月至2007年1月应用AF三维椎弓根螺钉系统治疗胸腰椎爆裂骨折102例,疗效满意,现报告如下。     

术中脊髓造影在后路手术治疗胸腰椎骨折伴神经损伤中的应用

我院骨科自1994年4月起对27例伴神经症状的新鲜胸腰椎骨折患者行后路SF复位内固定时进行了术中脊髓造影检查，报道如下。资料与方法本组男21例，女6例，平均年龄33岁。均为车祸或高处坠落伤，受伤至手术时间最短4h，最长12d。术前1d行碘过敏试验，均为阴性。受伤部位T112例，T1210例，L111例，L23例，L31例。骨折按Denis分型：压缩骨折2例（均为FergusonⅢ度），爆裂骨折25例。25例爆裂骨折按Denis爆裂骨折分型法：A型12例，B型10例，C型1例，D型1例，E型1例。神经损伤程度按Frankel分级法：B级6例，C级13例，D级8例。手术器械为SF…     

不稳定性胸腰椎骨折与脊髓损伤的治疗进展

不稳定性胸腰椎骨折与脊髓损伤的治疗进展方小飞脊柱骨折与脱位为骨科常见创伤之一，其中胸腰椎骨折占大多数。不稳定性胸腰椎骨折包括椎体严重的爆裂性骨折，椎体压缩超过１／２，屈曲旋转及平移剪力所致的骨折脱位。且易合并脊髓、马尾神经损伤、致残率高。为骨科治疗的...     

胸腰椎骨折与脊髓损伤的国内治疗进展

胸腰椎骨折与脊髓损伤的国内治疗进展安徽省无为县人民医院（２３８３００）方小飞随着ＣＴ的广泛应用，脊柱三维学说的建立，对脊拄骨折与脱位易合并脊髓、马尾神经损伤的治疗有了较大进展。本文就近年来国内对胸腰椎骨折及脊髓损伤的治疗现状作一简述。１．胸腰椎骨折的...     

胸腰椎骨折伴脊髓损伤的再手术

１９９１－１９９５年１４例胸腰椎骨折伴脊髓损伤患者，在初次术后因各种原因进行了再手术。其中椎管内骨片遗留８例，均再生全环减压术。伤椎定位错误２例。发现后重新人固定和再减压。骨折脱位复位不满意２例，均予再手术。脑脊液囊肿１例，予以囊肿切除，软组织重加压缝合。椎弓根螺钉断裂致脊柱后凸畸形１例，行后凸畸形截骨短形术。初次术后４例神经功能得到改善，１０例无效。而再次手术后经１２－３６月随访，７例获Ｆｒａｎ     

Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits

The results of surgical decompression (SD) in 59 patients with neurologic deficits secondary to thoracic or lumbar fractures were evaluated at a mean of 3.7 years after injury. The purpose was to determine whether SD could be correlated with subsequent neurologic outcome. Follow-up neurologic evaluations showed a greater neurologic improvement in the 20 patients who were treated with anterior spinal SD as compared to the 39 patients who received posterior or lateral SD (88% vs. 64%). The return of normal bowel and bladder control also occurred more frequently in the anteriorly SD group than the posteriorly treated SD group (69% vs. 33%). The inferior results in the posteriorly treated SD group appeared to correlate with a high incidence of bony stenosis as measured on postoperative computed axial tomography.     

前路ALPS内固定器在胸腰椎爆裂骨折并截瘫治疗中的应用

目的: 讨论脊柱前路手术和前路锁定钢板系统 (AnteriorLockingPlateSystem, ALPS) 治疗胸腰椎爆裂骨折合并截瘫的方法和疗效。方法: 对 35例胸腰椎爆裂骨折合并截瘫的患者行前路手术减压、复位、植骨和ALPS内固定器治疗。结果: 33例获得随访, 大部分患者的神经功能不同程度的恢复, 未见内固定物松动、断裂, 无明显后凸畸形复发。结论: 脊柱前路手术减压充分, 在有椎体间支撑植骨时, ALPS内固定器能提供坚强的固定, 符合生物力学要求。     

RF系统内固定治疗胸腰椎爆裂性骨折

目的 :总结应用RF系统内固定手术治疗胸腰椎爆裂性骨折的方法和治疗效果。方法 :脊柱后侧入路椎管探查减压或单纯使用RF系统内固定手术治疗胸腰椎爆裂性骨折 68例。结果 :经 6～ 3 6个月随访 ,椎体平均高度由术前的前 3 6 5 %和后 78 5 %恢复到术后的前 92 0 %和后 96 5 %,Cobb’s角由术前平均 15 6°恢复为术后平均 1 5°。对脊髓损伤的病人Frankel分级平均提高 1 5级。有 2例出现椎弓根钉松动 ,无断裂。结论 :RF系统结构简单 ,操作方便 ,固定确实 ,在脊柱内固定器械中具有较明显的优越性 ,有待进一步临床应用研究。     

Treatment of unstable fractures of thoracolumbar spine with neurologic injury using a reduction fixation spinal pedicle screws system]

Twenty-six patients with unstable burst fractures, chance fractures and fractures dislocations of the lower thoracic and lumbar spine were treated with a spinal pedical screw reduction fixation system (RF system). This system is a new device designed by Chinese scientists. In biomechanical testing, it provided three-dimensional reduction forces. The special design of angle pedicle screw provided accurate angle to restore the normal thoracic lumbar lordosis and to maintain it. The three-column spine in a lordotic position maximized the reduction and indirectly achieved a neurologic decompression in the spinal canal. All patients had an anatomical reduction by RF system except one case operated two weeks after injury, the spinal canal area increased over 30% by CT (P < 0.01). Except four cases with Frankle A out of twenty patients with neurologic deficits, all other patients had at least one grade progress. Of them one improved from A to D, ten from C and D to normal. These twenty patients were followed-up over six months. All of them maintained anatomical reduction by RF system. Bone grafting had successful fusion by follow-up X-ray examinations. There were no important complications after surgery. The system is of simple structure facilitation implantation and enable the patients beginning ambulatory movements early, therefore it gives more satisfactory results over conventional Harrington and other segmental spinal instrumentation systems.     

Management of thoracolumbar spine fractures

Background contextTraumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability.PurposeTo review the most current information regarding the pathophysiology, injury pattern, treatment options, and outcomes.Study designLiterature review.MethodsRelevant articles, textbook chapters, and abstracts covering thoracolumbar spine fractures with and without neurologic deficit from 1960 to the present were reviewed.ResultsThe thoracolumbar spine represents a unique system from a skeletal as well as neurological standpoint. The rigid rib-bearing thoracic spine articulates with the more mobile lumbar spine at the thoracolumbar junction (T10 - L2), the site of most fractures. A complete examination includes a careful neurologic examination of both motor and sensory systems. CT scans best describe bony detail while MRI is most efficient at describing soft tissues and neurological structures. The most recent classification system is that of the new Thoracolumbar Injury Classification and Severity Score. The different fracture types include compression fractures, burst fractures - both stable and unstable -, flexion-distraction injuries and fracture dislocations. Their treatment, both operative and non-operative depends on the degree of bony compromise, neurological involvement, and the integrity of the posterior ligamentous complex. Minimally invasive approaches to the care of thoracolumbar injuries have become more popular, thus, the evidence regarding their efficacy is presented. Finally, the treatment of osteoporotic fractures of the thoracolumbar spine is reviewed, including vertebroplasty and kyphoplasty, their risks and controversies, and senile burst fractures, as well.ConclusionsThoracolumbar spine fractures remain a significant source of potential morbidity. Advances in treatment have minimized the invasiveness of our surgery and in certain stable situations, eliminated it all together.     

C-D短节段椎弓根螺钉系统内固定治疗胸腰椎爆裂型骨折

Ｄ短节段椎弓根螺钉内固定系统国外已广泛应用于脊柱外科,我们于１９９７年１月开始应用ＣＤ技术治疗胸腰椎爆裂骨折,获得满意效果。１　病例资料本组１４例,男１２例,女２例,年龄２７～５３岁。骨折部位：Ｔ１２３例,Ｌ１６例,Ｌ２４例,Ｌ３１例。受伤距手术时间６ｈ～１２天,平均６天。完全性截瘫１例,不全瘫８例。２　手术方法　　全麻下取俯卧位后正中入路。根据椎体后缘骨块突入椎管程度选择是否行减压术。本组５例同时行经椎弓根侧前方减压术。分别于伤椎上下邻椎置入２对椎弓根螺钉。选取合适长１９９９０３１６收…     

椎板开窗椎管减压治疗伴神经损伤胸腰椎爆裂骨折

目的探讨椎板开窗椎管减压治疗合并神经损伤胸腰椎爆裂骨折的手术效果。方法回顾性研究自2008-01—2013-06采用椎板开窗椎管减压、椎弓根钉内固定治疗的28例合并神经损伤的胸腰椎爆裂骨折。术后1周、12个月行X线片和CT检查,测量椎体前缘高度、椎管中矢径和椎管狭窄。末次随访时记录腰背痛VAS评分和神经功能Frankel分级恢复情况。结果 28例均获得平均20.1(18~36)个月随访。术后1周与术前比较,椎体前缘高度(t=27.040,P0.001)、椎管中矢径(t=22.620,P0.001)、椎管狭窄(t=20.470,P0.001)明显改善,差异有统计学意义(P0.05)。术后12个月与术后1周比较,椎体前缘高度少许丢失,差异有统计学意义(t=16.970,P0.001),但基本维持稳定;椎管中矢径(t=8.480,P0.001)、椎管狭窄(t=10.150,P0.001)进一步改善,差异有统计学意义(P0.05)。末次随访时,除2例完全性神经损伤外,不完全性神经损伤患者均有不同程度恢复,由术前分级(2.75±1.21)恢复至(0.86±1.30),差异有统计学意义(Z=-4.435,P0.001);腰背痛VAS评分为(2.25±0.17)分,较术前明显降低,差异有统计学意义(t=19.390,P0.001)。结论椎板开窗椎管减压、椎弓根钉内固定治疗合并神经损伤的胸腰椎爆裂骨折不仅保留了椎管结构和脊柱稳定性,而且可以使椎管得到有效减压。     

胸腰椎严重爆裂骨折前路内固定治疗

目的评价前路Z-plate内固定系统治疗胸腰椎严重爆裂骨折的疗效。方法32例胸腰椎严重爆裂骨折患者行前路减压、植骨并Z-plate内固定系统治疗。结果32例随访6～20个月。平均植骨愈合时间3.5个月。神经功能根据脊髓损伤ASIA神经功能分类标准分级为:术前A级4例、B级5例、C级12例、D级8例、E级3例;术后:A级3例、B级3例、C级2例、D级3例、E级21例,总有效率为81.25%。结论前路Z-plate内固定系统治疗胸腰椎严重爆裂骨折具有良好的减压、固定效果,手术操作简单,植入方便。     

后路椎管内打平器结合AF钉治疗胸腰段椎体骨折

我院自 1997- 2 0 0 1年自行设计并应用椎管内打平器 (简称打平器 )结合AF钉后路手术治疗胸腰段椎骨折并截瘫病人 4 8例 ,取得了理想效果 ,现报告如下。1　临床资料1 1　材料及结构　打平器由医用不锈钢加工而成 ,长 2 0 0mm。从外观形状看主要由持手柄、连结柄、横槽、顶骨板等部分组成 (见图 1)。①持手柄 :长110mm ,14mm的圆柱体 ,其腹侧每相隔 2 0mm开设一个12mm的“指槽” ,共 4个“指槽” ,中间深度 4mm。②连结柄 :长 76mm ,为圆椎体 ,其下底 (连接手柄 )14mm ,上底 (连接槽 )7mm。③横槽 :长 11mm ,其背面及两侧面均为连接…