上胸椎骨折脱位的后路手术方法探讨

目的总结分析上胸椎骨折脱位的临床特点及手术治疗的效果。方法回顾性分析18例上胸椎骨折脱位的临床资料。3例单纯压缩性骨折予保守治疗，其余15例行后路切开复位、椎管减压、钉棒内固定、植骨融合术。结果18例均获得随访，平均时间2年1个月。A级10例术后无恢复；B级3例术后进到D级1例、C级2例；C级2例术后进到D级1例、E级1例；D级1例恢复正常；E级2例无恶化，无内固定失败。结论上胸椎骨折脱位的临床特点为损伤外力强大，脊柱、脊髓损伤严重，多发伤合并率高。对不稳定骨折即使是合并完全性脊髓损伤者，应尽量考虑早期手术减压并稳定脊柱，以利患者的早期康复治疗。

Investigation on methods of posterior approach for treatment of fracture and dislocation of upper thoracic vertebrate

Objective To analyze the characteristics and results of surgical treatment of fractures and dislocations of upper thoracic vertebrae.Methods Eighteen patients were treated surgically for fracture and dislocation upper thoracic vertebrae from March 2001 to August 2005. Among all cases 3 were treated conservatively and 15 with operative management.Both groups of these patients were evaluated clinically,radiographically,and functionally for a minimum of 8 months(mean 25 months).Results Twelve cases were multiple injuries or multiple fractures.10 patients had complete neurological injury,and 6 patients had incomplete neurological injury according to the Frankel classification.At the follow-up,no hardware failure was found.None of the Frankel A patients had neurological function improvement,6 of the non Frankel A patients had improvement of one or two Frankel grade.Conclusion Fractures of the upper thoracic vertebrae are severe injuries of spine and spinal cord,caused by violent forces with high incidence of multiple lesions.In order to gain optimal neurological recovery and rehabilitation,surgical decompression and stabilization should be considered for patients with unstable fracture even in cases complicated with complete neurological injury.