对无神经症状胸腰椎骨折治疗.docVIP

对无神经症状胸腰椎骨折治疗 　 作者：邵顺建，胡健，宋展昭，李洪鹏 【摘要】 [目的]针对无神经症状、椎管无明显占位的胸腰椎骨折，目前临床上有多种治疗方法，结合本院30例手术治疗经验，谈谈对各种治疗方法的体会。[方法]对30例无脊髓、神经压迫症状的胸腰椎骨折，采用钉棒系统内固定、张复椎体、损伤节段后外侧植骨的手术方式治疗。[结果]随访12～27个月，平均15个月，无内固定松动、断裂，伤椎高度及椎间角大部分恢复(Plt;0.05)，术前椎管狭窄率平均28%，术后为9%(Plt;0.05)。患者无远期腰背疼痛不适及脊髓、神经压迫症状出现。X线片及CT证实伤椎愈合好，虽伤椎内有小空洞改变，然足以维持支撑强度及刚度。[结论]对于无脊髓、神经症状出现，椎管无明显占位的胸腰椎骨折，采用钉棒系统内固定、张复椎体，结合后路损伤节段融合治疗，是可行的治疗方法，可立即缓解伤部疼痛，又可有效防止后期慢性腰背疼痛不适以及局部脊柱不稳定所致的脊髓、神经压迫症状的出现。内固定取出后，不会引起伤部脊柱成角加重和伤椎高度丢失。 【关键词】 胸腰椎; 骨折; 无神经损伤 　　Abstract：[Objective]To investigate the treatment of thoracolumbar vertebral fracture without nerve symptoms.[Method]Thirty cases of thoracolumbar vertebrae fracture without nerve and spinal cord symptoms were treated with vertebra body restitution,pedicle screw fixation and posterolateral bone fusion.[Result]All the cases were followed up for 1227 months,with an average of 15 months.There was no loosening and breaking of internal fixation.A great part of the height of the fractured vertebra body and the intervertebral body angle was restored(Plt;0.05).The spinal stenosis rate decreased from 28% before operation to 9% after operation(Plt;0.05).The patients had no longterm lumbar,back pain or nerve compression symptoms.The Xray and CT revealed that the fractured vertebra body was restored well.Although there were little cavitates in the vertebra body,the intensity and rigidity of the vertebra body was kept well.[Conclusion]For the thoracolumbar vertebral fracture without nerve symptoms or intracanal fragment,the operation of vertebra body restitution,pedicle screw fixation and posterolateral bone fusion is feasible.It can immediately reduce the pain of the injured portion,and prevent the late lumbar and back pain and other spinal cord and nerve compression symptoms caused by the unstable spine.After withdrawal of the internal fixation,no severe angulation and height lost of the fractured vertebra body will be found. 　　Key words：thoracolumbar; fracture; without neurological deficit 　自2002年2月-2006