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。

Low lumbar spine fractures

Objective To emphasize the unique characteristics and treatment of low lumbar spine fractures. Methods Forty-five patients with low lumbar spine fractures were retrospectively reviewed. Of these, there were 24 compression fractures, 14 burst fractures, three flexion - distraction fractures and four fracture - dislocations. Three patients had a completely neurological lesion, nine sustained a incompletely neurological injury, and 33 were neurologically intact. Twenty-six patients were treated nonoperatively and 19 underwent surgery. Results All patients were followed up for 1 - 15 years. As for neurological improvement, 33 patients had excellent results, four had good, and one had fair results. Seven patients had no change in their neurological function. Conclusion Because of the unique anatomy and biomechanics, fractures of the low lumbar spine are different from those in the remaining regions of spine. Most of compression fractures are stable, and therefore conservative management is indicated . Surgery should be performed in those with burst fracture or flexion - distraction fractures, with severe spinal stenosis or kyphosis deformity, and fracture - dislocation.