中上胸椎骨折合并脊髓损伤临床特点及治疗策略.doc

中上胸椎骨折合并脊髓损伤临床特点及治疗策略 　 作者：白金柱，洪毅　张军卫，唐和虎，姜树东，李想 【摘要】 [目的]探讨中上胸椎骨折合并脊髓损伤的临床特点及治疗策略。[方法]对2002年1月-2008年6月的40例中上胸椎脊柱脊髓损伤患者的临床资料进行回顾性分析。HanleyEskay分类:压缩骨折4例,爆裂骨折11例,骨折脱位23例,爆裂脱位2例。按美国脊髓损伤学会脊髓神经功能分级(ASIA标准)：A级29例,B级3例,C级4例，D级0例，E级4例。非手术治疗4例,手术治疗36例，均为后路减压复位植骨融合椎弓根钉内固定，术后早期康复治疗。[结果]40例均获随访，平均32个月。非手术治疗组，3例骨折愈合，无神经功能障碍，1例16个月后出现后迟发性后凸畸形合并神经功能损害，行前后路联合手术。手术治疗组，术后影像学复查,胸椎序列恢复良好，脊髓无压迫，内固定均无松动断裂,后路植骨已融合,椎弓根钉位置不良5枚,但畸形无加重。脊髓损伤A级29例中仅1例恢复至B级,B级3例中1例恢复至C级,C级4例中2例恢复至D级。伤后1周内MRI髓内出血信号长度lt;4 mm者4例随访时均获1个级别的提高。脊髓损伤患者早期康复治疗后日常生活动作能力(ADL)评分平均提高(22.53±6.25)分。[结论]中上胸椎骨折脊髓损伤发生率高且严重，多为完全性，预后差。伤后1周内MRI髓内出血信号长度lt;4 mm者预后相对较好。后路减压复位植骨融合椎弓根钉内固定治疗新鲜骨折可以取得较好的效果。脊髓损伤早期康复可提高患者生活自理能力。 【关键词】 胸椎; 骨折; 脊髓损伤 　　Abstract：[Objective]To analyze the clinical characteristics and treatment methods of uppermiddle thoracic fractures with spinal cord injury.[Method]Forty patients with uppermiddle thoracic fracture were retrospectively reviewed.HanleyEskay classification was used:compression fractures in 4,burst fractures in 11,fracturedislocations in 23,and burst dislocation in 2 cases.Neurologicall function(according to the ASIA classification):A in 29，B in 3,C in 4,D in 0,and E for 4 cases.Four cases without spinal cord injury received conservative treatment.Thitysix cases with spinal cord injury underwent laminectomy and reduction followed by posterior fusion with bone graft and pedicular screw instrumentation.All 36 cases received early rehabilitation.[Result]All 40 cases were evaluated clinically,radiographically,and functionally during the followup(mean,32 months).Conservative group:one case developed delayed kyphosis deformity with neurological deficit and underwent anteriorposterior surgical treatment 16 months tater.Surgical group:the correction in 3 patients was not complete on radiographs after operation.No loose screw or breakage was found,and the grafted bone was completely fused.Among the patients with spinal cord injury,one case in ASIA A improved to ASIA B,one case in ASIA B improved to A