多节段非相邻型脊柱骨折的诊治

目的 探讨多节段非相邻型脊柱骨折(multiple-level noncontiguous spinal fractures，MNSF)的致伤机制、临床特点及治疗方法。方法 回顾性分析2000年1月～2003年12月23例MNSF患者的临床资料。男15例，女8例。年龄13～75岁。原发损伤T11～L2 13例，T1～T10 7例，C2～C6 3例。原发损伤合并神经症状14例，继发损伤合并神经症状3例。神经损伤按Frankel分级：A级7例，B级1例，C级3例，D级6例，E级6例。16例行手术治疗，7例行非手术治疗。结果 1例术后4d死亡，2例失访，20例获随访3个月～4年，平均11．5个月。无神经症状加重、切口感染、内固定失败及植骨不融合发生。术前有神经症状的17例中，12例Frankel分级改善1～3级，其中6例D级、2例C级和1例B级恢复至E级，1例C级恢复至D级，2例A级恢复至B级；余5例均为Frankel A级患者，其中4例无变化，1例术后死亡。结论 MNSF致伤机制复杂，易漏诊，应仔细全面检查脊柱损伤患者，必要时摄脊柱全长X线片。根据骨折稳定性、脊髓神经损伤情况采取相应的治疗方法。

DIAGNOSIS AND TREATMENT OF MULTIPLE-LEVEL NONCONTIGUOUS SPINAL FRACTURES

Objective To explore the injury mechanism, clinical features and treatment methods of multiple-level noncontiguous spinal fractures(MNSF). Methods The clinical data of 23 patients with MNSF were analyzed retrospectively. There were 15 males and 8 females aging from 13 to 75 years. Five cases missed diagnosis. The locations of the primary injury were cervical region in 3 cases, thoracic region in 7 cases, and thoracolumbar region in 13 cases. The spinal fractures associated with spinal cord injury were 14 cases in the primary injury, and 3 cases in the secondary injury. According to Frankel grade, there were 7 cases of grade A, 1 case of grade B, 3 cases of grade C, 6 cases of grade D and 6 cases of grade E. Sixteen cases were treated by surgical stabilization while 7 cases were treated conservatively. Results Twenty patients were followed up from 3 months to 4 years with a mean of 11.5 months except three patients. No neurologic deterioration was observed in patients who were treated conservatively or operatively. No wound infection, no implant failure or bone graft nonunion occurred in patients who were treated operatively. Among 17 patients with neurologic deficit before operation, 12 got 1-3 grade improvement of the Frankel grading, 4 remained unchanged and 1 died. Conclusion The mechanism of MNSF injury is complex, it is easy to miss diagnosis. The patients with spinal injury must be examined carefully and completely. A whole spine radiographic survey should be accomplished if necessary and treatments should be based on the stability of spine fractures and the severity of spinal cord injury.