【摘要】 目的　探讨在AF内固定术中结合脊髓造影治疗胸腰段骨折脱位的临床意义。方法　 32例胸腰段骨折脱位伴不同程度神经损伤患者均行开放复位AF内固定手术治疗 ,术中暂不行椎管直接减压。AF复位内固定后 ,用Omnipaque造影剂 ,由手术切口行术中脊髓造影 ,注入造影剂前 ,回抽脑脊液 ,检查是否为血性 ,如为血性 ,不行此检查 ,造影后 ,C形臂X线机动态观察椎管通畅情况 ,了解减压复位情况 ,决定进一步治疗方案。结果　 32例患者中 ,除 2例为血性脑脊液未行此检查外 ,30例均行此检查 ,2 0例显示椎管通畅 ,骨折脱位得到解剖复位。生理曲线得到恢复 ,造影剂通畅无受压。未行椎管直接减压 ,占6 6 6 %。 6例显示椎管不畅 ,压迫来自前方。 4例行后路椎弓根侧前方减压 ,2例行骨块轻敲复位。 4例显示椎管不畅系后方压迫造成 ,行椎板减压。平均随访 36个月 ,所有病例均得到解剖复位 ,无复位丢失 ,不全瘫患者术后功能提高 1级或 1级以上者占 73 3%。结论　不是所有胸腰段骨折脱位患者都必须行切除椎管结构进行直接减压 ,复位固定本身即是椎管减压 ,术中脊髓造影简单、安全 ,直观。可术中监护复位减压情况 ,及时弥补不足 ,对进一步治疗有一定指导意义更多还原

【Abstract】 Objective To study of clinical significance of myelograph in operation of AF fixation for treatment of thoracolumbar fracture and dislocation.Methods Thirty two cases of thoracolumbar fracture and dislocation with different degree nervours injury were reduced by AF fixator.Decompression of spinal canal wasn’t performed in operation for the moment.Myelograph was carried out after AF fixation.But this examination wans’t performed if blood cerebrospinal fluid.The plan of treatment was decided by clear situation of spinal canal under x-ray fluoroscopy with c-type shape.Results Two cases with blood cerebrospinal fluid wasn’t examined in this method.Thirty cases were performend in myelography in operation.Twenty(66.6%) cases shown spinal canal clear weren’t taken a decopression of spinal canal.Laminectomy was performed in 6 cases with compression of spinal canal.Anterior decompression was performed in 4 cases with compression of anterior spinal canal.Average follow-up time were 36 months.All patients were obstain restoration of dissertion and no lose restoration.One or more levels recovery of in complete spinal cord injury was 73.3%.Conclusions No all patients with thoracolumbar fracture and dislocation with nervours injury must decompress through cut off spinal canal structure.Restoration-self is spinal canal decompression.Myelography in operation can observe curcumtance of restoration or decompression,so that make up for a loss in time.It simple,safe audion-visual.It has a significance of guide for treatment.更多还原