【作者】 杨物鹏； 付万有； 闫占明； 杨永晨； 白锋； 王新亮； 周权；

【Author】 Yang wu peng,Fu Wan You,Yan Zhan Ming et al,the Department of Orthopaedics,ORDOS Central Hospital,Inner Mongolia,China 017000

【机构】 内蒙古鄂尔多斯中心医院骨科；

【摘要】 目的:总结分析中上胸椎骨折脱位的临床特点及后路手术的治疗效果。方法:对中上胸椎骨折脱位26例患者的临床资料进行了回顾性分析,AO分型:A型9例,B型12例,C型5例,而完全性瘫痪7例,不完全性瘫痪19例。均采用后路手术复位植骨内固定,固定节段为2～4节,根据脊髓受压情况进行后路复位椎管内减压及植骨。结果:经X线复查,有1例复位欠佳,经6～72个月的随访,无内固定松动断裂,后路植骨已融合。ASIA分级中A级7例中有3例恢复至B级,1例恢复至C级,B～D级19例中均有1～2级的恢复。结论:中上胸椎骨折脱位的临床特点骨折累及节段多,脱位发生率高,脊髓损伤严重,对于此类患者应尽量考虑早期手术后路减压、复位、植骨内固定,对不稳定骨折即使是合并完全性脊髓损伤也应考虑早期减压并稳定脊柱,以利患者的早期康复治疗。更多还原

【Abstract】 Objective To analyze the characteristics and surgical treatment of upper-middle thoracic spine fracture and dislocation.associated with different degrees of dislocation.Methods 26 patients with upper-middle thoracic fracture and dislocation were retrospectively evaluated.There were 12 patients with type B and 5 patients with type C and 7 patients with type A according to the AO thoracolumbar fracture classification.According to the ASIA classification,7 patients had complete neurologicaldeficit,and 19 patients had incomplete neurological deficit.All patients underwent laminectomy and reduction followed by posterior fusionwith bone graft and instrumentation.The range of fixation extended from 2 levels to 4 levels,based on the situations or fact of spinalcord injury to perform decompression in spinal canal.Results The correction in one patient was not complete on radiographs after operation.The patients were followed up from six months to three years.No loose screw or breakage was found,and the grafted bone was completely fused.Among the patients in grade A,three patients had improved to grade B,and one patient had improved to grade C.The other patients in grade B to D had improved 1 to 2 grades.Conclusion The clinical characteristics of the upper-middlethoracic fracture are involvement of more spine vertebral levels,high dislocation incidence,serious spinal cord injury.Decompression and reduction followed byposterior fusion with bone grafting and instrumentation are an ideal surgical method to treat these patients.更多还原