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胸腰椎爆裂骨折外科治疗策略(1)
http://www.100md.com 2011年6月5日 吕春生
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     【摘要】 目的 探讨胸腰椎爆裂骨折外科治疗策略。方法 采用胸腰椎后路椎弓根螺钉固定术治疗胸腰椎爆裂骨折36例,对比患者手术前后神经功能评价、影像学指标及自我满意率。结果 平均随访42个月,Frankel评分平均提高1~2级;Cobb角由术前平均23°恢复至2.3°;椎体前后缘高度分别由术前平均37.5%(12.0%~46.0%)和79.0%(31.0%~87.0%)恢复到术后平均92.5%(90.0%~100%)和97.4%(94.5%~99.8%),18例术后CT扫描椎管内占位分别由61%恢复至32%;术后优良率(自我满意率)为88%。结论 手术治疗可使患者尽早恢复日常生活,有效恢复脊柱序列及椎管容积、矫正后凸畸形,有利于胸腰椎功能的恢复。

    【关键词】胸椎;腰椎;脊柱骨折;外科手术

    Analysis the surgical treatment of thoracolumbar burst fractures

    LV Chun-sheng.Department of Orthopaedics,Ningxia Xiji country People’s Hospital,Xiji 756200, China

    【Abstract】 Objective To evaluate the strategy of surgical management for thoracolumbar burst fractures.Methods 36 cases of thoracolumbar burst fractures were treated with pedical screw system through posterior approach.Frankel scores and Cobb angles on X-rays before and after operation were evaluated and compared.Spinal canal encroachment were compared on preperative and postoperative computed tomography(CT)scans.Results The mean follow-up period was 42 months.Frankel scores improved 1~2 grades on average.The mean Cobb angle restored from 23 degrees preoperatively to 2.3 degrees postoperatively.The mean heights of anterior and posterior edge of centrums restored respectively from 37.5%(12.0%~46.0%)and 79.0%(31.0%~87.0%)preoperatively to 92.5%(90.0%~100%)and 97.4%(94.5%~99.8%) postoperatively.The mean spinal canal encroachment from 61% to 32% by CT scans in 18 cases.Neurological function improved in all cases,and the satisfactory rate was 88%.Conclusion Surgical treatment is effective to thoracolumbar burst fractures,which can help patients recover their daily lives earlier,effectively restore the alignment and volume of spinal canal and correct the kyphosis for the recovery of thoracolumbar function.

    【Key words】Thoracic vertebrae; Lumbar vertebrae; Spinal fractures; Operative surgical procedures

    胸腰椎爆裂骨折是临床上常见的损伤,该损伤常伴有神经功能损害,遗留各种后遗症,给家庭和社会造成很大的负担。治疗目的是:①直接或间接减压恢复神经功能。②恢复脊柱序列、椎体高度及椎管容积。③重建脊柱稳定性,使患者早期下床活动以减少肺部及全身其他并发症。后路椎弓根固定治疗脊柱爆裂骨折是目前最常见的手术方式之一。现就本院2002年1月至2006年12月收治胸腰椎爆裂骨折36例,分别采用单纯后路固定或后路固定植骨融合、椎板减压的手术方法,36例均随访6~48个月,效果满意。

    1 资料与方法

    1.1 一般资料 本组36例,其中男26例,女10例。年龄18~65岁 ......

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