多节段椎弓根螺钉内固定治疗中上胸椎骨折脱位

目的：回顾分析一组多节段椎弓根螺钉内固定治疗中上胸椎骨折脱位的临床资料,探讨多节段椎弓根螺钉内固定的治疗效果及理论依据。方法：胸椎骨折脱位23例,男21例,女2例;年龄20～47岁,平均33.5岁。以累及椎体统计,23例共31椎体：T22椎,T32椎,T45椎,T56椎,T610椎,T74椎,T82椎。压缩骨折3例,爆裂骨折7例,骨折脱位9例,爆裂脱位4例。行多节段椎弓根螺钉内固定治疗中上胸椎骨折脱位。结果：所有患者获随访,时间3～48个月,平均25.5个月。均无术中严重并发症发生,伤椎前缘高度由术前平均40.4%,恢复到术后平均90.3%;脊髓不完全损伤患者ASIA分级提高1～2级,脊髓完全损伤的患者感觉运动评分有不同程度上升,平均上升21.7分。结论：在中上胸椎骨折脱位治疗方面,多节段椎弓根螺钉内固定对损伤节段可得到满意的复位及固定效果,而且有效地预防远期伤椎椎体高度的丢失和内固定失败。

Clinical study on multi-segmental pedicle screw implantation in the treatment of middle-upper thoracic spine fracture and dislocation

Objective: To review a group of clinical data of pedicle screw implantation in the treatment of middle-upper thoracic fracture and dislocation and explore these clinical effect. Methods: Through the retrospective analysis of 23 patients (31 vertebraes) of middle-upper thoracic fracture and dislocation included 21 male and 2 female,aged from 20 to 47 years in average of 33.5 years. The location and type of fractures were as follows:2 in T₂,2 in T₃,5 in T₄, 6 in T₅,10 in T₆,4 in T₇,2 in T₈. Three cases were compression fractures,7 burst fractures,9 fracture-dislocations,4 burst-dislocations. Results: After a followed-up from 3 to 48 months,average 25.5 months,all cases had no serious complications. Anterior height of affected vertebral bodies had been restored from 40.4% to 90.3% after operation. Patients with incomplete spinal cord injuries improved one to two grades according to ASIA grade of spinal cord injury. Patients with complete spinal cord injuries improved 21.7 scores on average according to Sensory and Motion Scores. Conclusion: Multi-segmental pedicle screw implantation for the injuries of vertebral body may get satisfactory reduction and fixation effects,and prevent the long-term loss of the vertebral body height and implanting failure.