摘要
目的探讨多节段椎弓根螺钉内固定治疗中上胸椎骨折脱位伴脊髓损伤的临床效果。方法采用经多节段椎弓根螺钉内固定治疗中上胸椎骨折脱位15例。按受累椎体统计,15例共20椎:T43椎,T65椎,T710椎,T82椎。按Hanley-Eskay分类:爆裂骨折6例,骨折脱位7例,爆裂脱位2例。术前脊髓神经功能按美国脊柱脊髓损伤协会(ASIA)标准分级:A级6例,B级4例,C级4例,D级1例。均行胸后路复位、椎管减压、多节段椎弓根螺钉内固定、后外侧植骨融合术。结果 15例均获随访,平均20.3个月,术后伤椎前缘高度由术前平均40%恢复至术后90.3%,术后脊髓神经功能恢复按ASIA标准,除A级及1例B级无恢复外,余8例均有不同程度改善。无内固定松动及断裂,无伤椎高度及脊柱生理弧度再丢失。结论多节段椎弓根螺钉固定可靠,能达到良好的复位和减压目的,有利于患者的早期康复。
Objective To study the effects of pedicle screw implantation in the treatment of middle-upper thoracic fracture and disloca- tion with spinal cord injury. Methods Fifteen patients （20 vertebraes） with uppermiddle thoracic fracture were retrospectively reviewed. The location and type of fractures were as follows ：3 in T4,5 in T6, 10 in T7,2 in T8,Hanley-Eskay classification was used ：burst fractures in 6, fracture- dislocation in 7, and burst dislocation in 2 cases. Neurologicall function （according to the ASIA classification）：A in 6, B in 4, C in 4, and D for 1 case. All patients received surgical methods with posterior approach decompression and reduction followed by fusion with bone grafting and pedicle screw instrumentation. Results All cases were followed up for 10-26 months（average 20.3 months）.During the follow up, the anterior vertebral body height was restored from preoperative 40% to postoperative 90.3%. According to the ASIA classi- fication,none of the grade A patients had neurological function improvement,other patients had improvement of one or two grade except only one grade B patient.There was no postoperative neurologic deterioration, screw loose or breakage of the internal fixation, or loss of the normal spine curve and the spinal height of the injured vertebra.Concluksion Multi-segmental pedicle screw implantation for the injuries of vertebral body may get satisfactory reduction and decompression. The effect of fixation is perfect,optimal neurological recovery and rehabilitation are available to patients.
出处
《中国骨与关节损伤杂志》
2010年第9期772-774,共3页
Chinese Journal of Bone and Joint Injury
关键词
椎弓根螺钉
胸椎骨折脱位
脊髓损伤
植骨融合
Pedicle screw implantation
Thoracic fracture and dislocation
Spinal cord injury
Fusion with bone grafting
