胸椎椎弓根钉在上胸椎骨折脱位的临床应用

目的 总结分析中上胸椎骨折脱位的临床特点及手术治疗的效果.方法 对11例中上胸椎骨折脱位患者的临床资料进行了回顾性分析研究.新鲜骨折11例.6例多发创伤或多发骨折.根据AO骨折分类:B型7例,C型4例.手术方法为后路减压植骨融合椎弓根钉内固定.结果 9例获得随访,时间13～33个月,平均15个月,其中4例术前Frankel A级无1例改善,非A级者4例有一级改善,1例无变化,无内固定失败.结论 中上胸腰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.

Surgical treatment of upper-middle thoracic fracture and dislocation

Objective To analyze the characteristics and results of surgical treatment of thoracic fractures and dislocations. Methods patients were treated surgically for thoracic fracture and disiocation from 2003 to 2005. of these patients were evaluated clinically, radiographically, and functionally for a minimum of 13 months(mean 15 months). Results There were 11 fresh injuries; 6 were multiple injuries or multiple fractures; 6 were multi-segmental fractures. There were 7 type B injuries and 4 type C injuries had incomplete neurological injury according to the Frankel classification. 11 patients underwent posterior procedure. At the follow-up, no hardware failure was found. None of the Frankle A patients had neurological function improvement. 4 of non Frankel A patients had improvement of one Frankel grade, and 4 had little improvement. Conclusions The upper-middle thoracic fractures are severe injuries of spine and spinal cord caused by violent foreces with high incidence of multiple lesions. In order to gain optimal neurological recovery and rehabilitation, surgical decompressin and stabilization should be considered for patients with unstable fracture even complicated with complete neurological injury.