之胸腰椎骨折 撑开与韧带整复复位后路器械固定 转.docVIP

之胸腰椎骨折 撑开和韧带整复复位后路器械固定 转 Thoracolumbar Fracture：Posterior Instrumentation Using Distraction and Ligamentotaxis Reduction胸腰椎骨折：采用撑开和韧带整复复位后路器械固定Thoracolumbar burst fracture occurs when the vertebral body is subjected to asignificant axial force that brings about compression failure of the anterior and middle columns of the spine.1 Most burst fractures involve the thoracolumbar junction,which is uniquely susceptible to this type of injury because of its transitional anatomy and its location between the stiff,kyphotic thoracic spine and the more mobile,lordotic lumbar region.Unlike purely compressive fractures,in which the middle spinal column remains intact,burst injuries typically are associated with some degree of spinal canal occlusion,which may result in neurologic deficits.当椎体受到轴向暴力产生脊柱前、中柱压缩破坏时可发生胸腰椎爆裂性骨折。大多数爆裂性骨折容易发生在胸腰段连接处，主要是因为胸腰段解剖结构和所处位置不同，胸段特点是活动度小并向后凸，而腰段活动度较大且向前凸。单纯性压缩性骨折时脊柱中柱保持完好，而典型的爆裂性损伤与单纯压缩骨折不同，它可发生一定程度的椎管受累，从而导致神经功能障碍。Many stable thoracolumbar burst fractures are treated nonsurgically with external immobilization and early ambulation.However,the patient who exhibits spinal instability,progressive spinal deformity,or an incomplete spinal cord injury is often an appropriate candidate for surgical intervention.In these presentations,the goals of surgery are to restore spinal stability through fracture stabilization and to improve functional outcomes by decompressing the neural elements.许多稳定的胸腰段爆裂性骨折采用制动和早期下床活动等非手术治疗。然而对于脊柱不稳定、进行性脊柱畸形或不完全性脊柱损伤的患者通常适合手术治疗。对这些情况进行手术的目的在于通过稳定骨折恢复脊柱的稳定性、通过减压改善神经功能。There is agreat deal of controversy regarding the optimal surgical approach(ie,anterior,posterior,circumferential)for treating apatient with athoracolumbar burst fracture.Posterior instrumentation techniques are frequently used in this clinical scenario because they facilitate fracture reduction and subsequent arthrodesis.At the same time,indirect decompression of the spinal canal may be accomplished through distraction and ligamentotaxis,a process that effective