胸腰段脊柱骨折合并创伤性膈疝的诊断与治疗

目的：探讨胸腰段脊柱脊髓伤合并创伤性膈疝的诊断和治疗。方法：回顾性分析我院1985年1月～2004年12月收治的此类伤21例。骨折按Denis分类：爆裂型9例，压缩性骨折2例，骨折脱位10例。神经功能按ASIA分级：A级7例，B级5例，C级6例，D级3例。结果：左侧膈疝18例，右侧膈疝3例。24h内确诊11例，48h内确诊5例，72h内确诊4例，漏诊死亡1例。生存20例，随访6个月～12年，平均4年2个月。神经功能ASIAA级7例中部分感觉功能恢复4例，其余神经功能均较术前改善1—3级。手术并发症中后路脱钩1例，椎弓根钉断裂2例。结论：对胸腰段脊柱脊髓损伤合并创伤性膈疝的患者应全面仔细地体格检查及X线或CT检查。治疗时应优先处理膈疝，如果患者情况许可同期行膈肌修补和脊柱固定手术。

Diagnosis and Treatment of Thoracolumbar Fracture with Traurmatic Diaphragmatic Hernia

Objective：To discuss the diagnosis and treatment of thoracolumbar fracture combined with traurmatic diaphragmatic hernia. Methods：From January 1985 to December 2004, 21 cases of thoracolumbar fracture with traurmatic diaphragmatic hernia were retrospectively analyzed. According to Denis classification, burst fracture in 9 cases, compression fracture in 2 cases and fracture dislocation in 10 cases. Base on A- SIA classification, grade A in 7 cases, grade B in 5 cases, grade C in 6 cases and grade D in 3 cases. Results：Diaphragmatocele was noted on left in 18 cases and on right in 3 cases. Diagnosis was definite within 24 hours in 11 cases, 48 hours in 5 cases and 72 hours in 4 cases, 1 patient was died because of missed diagnosis. The follow-up duration was 0.5-12 years （average 4 years and 2 months）, the sensory function was partly recovered in 4 of 7 grade A patients and improved 1-3 grade in the rest cases. Post-op complications included 1 case of posterior hook release and 2 cases of pedicle screw breakage. Conclusion： For patients with thoracolumbar fracture combined with traurmatic diaphragmatic hernia, physical examination, X-rays or computerized tomography should be carried out. Meanwhile, Diaphragmatocele can handle in priority, diaphragmatic muscle repair and spinal internal fixation can perform in the corresponding time period if the patient＇s condition is allowed.