胸腰椎骨折伴脊髓损伤手术方式选择.pdf

中国矫形外科杂志2001年2月第8卷第2期OrthopJChin,Vol.8,No.2February2001·731·

·论著·

胸腰椎骨折伴脊髓损伤手术方式选择

林本丹钟志刚邱雪立胡奕山周来喜

摘要目的:探讨胸腰椎骨折伴脊髓损伤前后路手术各自的优缺点、适应证以及内固定物的选择。方法:回顾
1992年1月～2000年4月手术治疗胸腰椎骨折伴脊髓损伤53例,其中后路手术43例,前路手术10例;总结手术方法及
手术疗效。结果:获6个月以上随访41例,脊髓神经功能术前为A级3例,术后均无恢复;其他在术后均有1-3级恢
复;前后路手术对神经功能恢复无法做比较;椎体复位后路手术43例有11例欠佳,前路手术10例均达解剖复位。结
论:前后路手术各有其较明确的适应证,应按照受伤节段、CT显示椎骨受压情况及神经损伤程度进行选择;后路手术存
在远期或取钉之后椎体高度再丢失问题,前路因其能达到生物学固定而远期稳定效果良好。
关键词脊柱骨折;胸椎;腰椎;内固定
中图分类号R683.1文献标识码A文章编号1005-8478(2001)02-0137-03

TheSelectionofoperativeProceduresforThoraco-lumbarFractureComplicatedwithSpinalCordInjury∥LINBen2
dan,ZHONGZhi2gang,QIUXue2li,etal.DepartmentofOrthopedics.GuangdongShantou515031
AbstractObjective:Toexploretheeffectsandindicationsofanteriororposteriorapproachoperationtotreatthoraco-
lumbarfracturecomplicatedwithspinalcordinjury;todiscusstheselectionofthematerialofinternalfixation.Methods:53cas2
esofthoraco-lumbarfractureaccompaniedwithspinalcordinjurywereoperatedfromJan.1992toApr.2000.43caseswere
treatedbyposteriorapproachoperationand10casesbyanteriorapproach.Results:41caseswerefollowed-upover6months.3
casesthatASIA(AmericanSpinalInjaryAssociation)impairmentscaleofpreoperationshowedAhadnorecovery.Otherswere
recoveredfrom1-3scaleafteroperation.Thelevelofrecoveryofspinalcordinjurycouldnotbecomparedbetweenanteriorap2
proachandposteriorapproach.In43casesofposteriorapproachoperation,11casescouldnotrecovertheheightofvertebralbody
afteroperation.Inall10casesofanteriorapproachoperation,thefractureofvertebralbodyachievedanatomicalreduction.Con2
clusions:Theindicationsanteriorapproachandposteriorapproachoperationcouldbedefinedaccordingtothesegmentofinjured
vertebra,thecompressedpositionofspinalcordthatwasshowedbyCTandtheimpairmentscaleofspinalcord.Thattheheight
ofvertebralbodylostagaincouldbefoundinlong-termfollow-upintheposteriorapproachoperation.Thelateresultofthe
anteriorapproachoperationwasgoodbecauseitcouldachievethebiologicfusionintheinjuredvertebralbody.
KeywordsSpinalfracture;Thoracicvertebrae;Lumba