手术治疗胸腰椎非相邻节段脊柱骨折

目的探讨胸腰椎非相邻节段脊柱骨折(MNSF)的手术治疗方式及疗效。方法对36例MNSF患者采用经脊柱后路椎弓根钉棒系统复位内固定、选择性植骨,根据骨折椎体损伤程度、部位和伤椎比邻关系,15例选择长节段固定,21例选择分节段固定;其中24例胸腰椎爆裂骨折行椎管减压术。根据患者术前与术后随访时的主要骨折椎体前缘高度、后凸Cobb角及ASIA分级变化进行疗效分析。结果 36例均获随访,时间24~48(36.5±9)个月。骨折均获得骨性愈合,脊柱序列明显恢复,未出现内固定物松动、断裂。椎体前缘高度及矢状面后凸Cobb角:术后7 d及末次随访与术前比较差异均有统计学意义(P0.05),末次随访与术后7 d比较差异无统计学意义(P0.05)。脊髓神经功能:术后7 d ASIA分级较术前有明显改善(P0.01)。结论胸腰椎MNSF应根据脊髓损伤的严重程度、骨折部位的稳定性及骨折的类型采用个性化手术方式,可使受压迫的脊髓神经充分减压,恢复并重建脊柱正常解剖序列,保持脊柱良好的稳定性。

Surgical treatment of thoracolumbar multiple-level noncontiguous spinal fractures

Objective To study the surgical treatment method of thoracolumbar multiple-level noncontiguous spinal fractures（MNSF） and to evaluate its clinical effect. Methods 36 patients with MNSF were treated through internal fixation with pedicle screw-rod spine instrumentation and selective bone graft. 15 cases were treated with long-segment, the others 21 cases with short-segment. 24 patients were treated with posterior selective vertebral canal decompression. The anterior vertebra height and Cobb angle and ASIA grade of pre-operation and post-operation were analyzed. Results All cases were followed up for 24 - 48 （36. 5 ± 9） months. All eases achieved bone fusion and without implant failure. Anterior vertebra height and Cobb＇s angle between pre-operation and post-operation were all significantly different for 7 days postoperation and last follow-up compared with the preoperation （ P 〈 0. 05 ）. At 7 days after surgery and last follow-up, the data did not show significant difference （ P 〉 0.05 ）. According to the ASIA grade of spinal nerve function,all improvements showed significant differences on 7 days postoperation （P 〈 0. 01 ）. Conclusions The treatment method of MNSF should be determined according to the severity of spinal cord injury, the stability and the types of spine fractures. The treatment strategies should be individualized, in order to obtain decompression, restoring of the normal spinal structure and stability of spines.