浮椎损伤的诊断及早期治疗探讨

目的:探讨浮椎损伤的临床特点及早期治疗原则。方法:椎间结构严重损伤、椎体附件骨折伴椎体严重的前侧方脱位患者6例,男4例,女2例;年龄24⁵8岁,平均36岁。6例均有不同程度的脊髓损伤,按Frankel分级,A级2例,B级3例,C级1例。早期手术探查及选择不同的内固定和植骨方式,5例采用长节段经椎弓根后路固定,1例采用短节段经椎弓根后路固定;2例采用单纯椎体间植骨,3例采用椎间融合器植骨,1例采用关节突及椎板后外侧植骨。结果:6例均获随访,随访时间12¹8个月,平均15个月。无术中血管、神经损伤;未见内固定松脱、断裂等并发症。6例均获骨性融合,术后未发生椎体再滑脱。脊髓功能Frankel分级:2例A级者术后无改善,3例由B级恢复至D级,1例由C级恢复至E级。结论:脊柱极度不稳,脊髓损伤可能相对较轻,由于脊髓、神经根可能因逃逸而避免严重损伤,长节段经椎弓根后路固定及植骨融合有利于维持伤椎间的稳定,浮椎损伤早期手术复位容易,椎间植骨能获得较高骨性融合率。

Diagnosis and early treatment of the floating vertebra trauma

Objective: To investigate the clinical characteristics and primary treatment of the floating vertebra trauma. Methods: Six patients (4 male and 2 female; the average age of 36 years ranging from 24 to 58 years) with major injury of intervertebral structure, appendix fracture of vertebra and severe anterolateral dislocation of vertebra were treated. According to Frankel classify, the level of spinal cord injury in 6 patients were graded into grade A in 2 cases,grade B in 3 cases,grade C in 1 case. Six patients were managed with early operative probing and different internal fixation or bone graft. Five patients were operated with long segmental internal fixation of the pedicle screw and the other one did with short segmental internal fixation of the pedicle screw through posterior approach. Two patients were treated by bone implantation between two vertebra, three patients by bone implantation of intervertebral cage and the other one by bone implantation of articular process and posterolateral vertebral plate. Results: Six patients were followed-up for an average of 15 months (range 12 to 18 months). No complication of the injury of the vessels or nerve endings were found. There was no loosening and breakage of the plate and screw. Bone fusion was obtained in all 6 cases. No any case took place redislocation. The spinal cord functions of all patients had improved except 2 cases of grade A of Frankel, 3 cases recovered from B to D and 1 case from C to E. Conclusion: If spine is utmost instable, spinal cord injury is probably slight. Early surgical reduction is easy to perform in treatment of the floating vertebra trauma. The long segmental internal fixation of the pedicle screw through posterior approach combined with bone graft can retain stable between vertabrae. Intervertebral grafting can gain a solid bone fusion rate.