胸腰椎爆裂型骨折的外科治疗

目的探讨胸、腰椎爆裂型骨折的外科治疗策略。方法回顾性分析1998年1月~2004年5月手术治疗的胸、腰椎爆裂型骨折患者59例,男42例,女17例,年龄19~58岁,平均38岁。受伤节段为T11~L3。侧位X线片示骨折椎体楔形变。骨折椎体高度压缩程度为1/4~3/4(在侧位X线片上骨折椎体前、后缘高度与相邻上下节段椎体前、后缘高度的平均值之比)。其中后路手术43例,前路手术16例。结果全部病例随访12个月~3年,平均21个月,椎体前、后缘高度分别由术前平均37.5%(12.0%~46.0%)和79.0%(31.0%~87.0%)恢复到术后92.5%(90.0%~100%)和97.4%(94.5%~99.8%),Cobb角由术前平均23°(13°~39°)恢复到术后平均2.3°(1°~6°),脊髓损伤患者按Frankel分级,除5例A级无明显改善外,其余病例均有明显改善,平均改善1级以上。结论胸、腰椎爆裂型骨折手术治疗的疗效是肯定的,手术方式的选择依术者所在医院的条件、医师手术技巧及患者的病情而定。

Surgical management of thoracolumbar bursting fractures

Objective To study the strategy of surgical management for thoracolumbar bursting fractures.Methods A retrospective analysis of 59 cases of thoracolumbar bursting fractures treated surgically from January 1998 to May 2004 was performed. There were 42 males and 17 females with mean age of 38 years (range 19-58 years). The involved vertebraes were from T₁₁ to L₃. All the lateral X-ray films showed wedging of the fractured vertebraes. The fractured vertebraes were compressed by 1/4 to 3/4 of normal height(the ratio of mean heights of the anterior and posterior edge of fractured vertebrae to those of the adjacent upper and nether segment on the lateral X-ray films). Of the 59 cases, 43 received posterior surgeries, and 16 anterior surgeries.Results All the patients were followed up for 12 months to 3 years (mean 21 months). The mean heights of anterior and posterior edge of centrums restored respectively from 37.5% (12.0%-46.0%) and 79.0% (31.0%-87.0%) preoperatively to 92.5% (90.0%-100%) and 97.4% (94.5%-99.8%) postoperatively, and mean Cobb angles from 23 (13-39) degrees to 2.3 (1-6) degrees. According to Frankel grade, all of the cases with spinal cord injuries were improved by above one grade except 5 cases in A grade without any improvement.Conclusion Surgical management of thoracolumbar bursting fractures is effective. The choice of operative method should be made on the basis of the hospital condition, surgical technique and the patient's condition.