胸腰椎爆裂骨折手术治疗的研究进展

脊柱骨折年发病率约64/100000[1]。随着交通、工业建筑事故的不断增加，胸腰椎骨折的发病率呈逐年上升趋势。脊柱胸腰段( T11～L2)处于相对固定的后凸脊柱与活动的前凸脊柱的转换区域，应力相对集中而容易受到传导暴力的直接损伤[2]，该部位骨折约占脊柱创伤75%～95%，椎体发生爆裂骨折后，后缘骨折块往往突入椎管导致脊髓或马尾损伤。近年来，随着影像学、生物力学对胸腰椎骨折研究的不断深入，在治疗方面也出现了许多新理论、新技术，但手术与否、手术时机、手术入路、术式的选择方面，仍有争议；现将研究状况综述如下。

多节段非相邻型脊柱骨折的研究现状

多节段非相邻型脊柱骨折(multiple-level noncontiguous spinal fractures,MNSF)又称跳跃型脊柱骨折,是指受伤后脊柱骨折多于一个节段,且至少被一个正常节段所分隔.此类骨折的特点是损伤暴力大,致伤机制复杂,常合并其他损伤,易漏诊或延迟诊断等.笔者就该类型骨折近年的研究现状作一综述.

跳跃式腰椎爆裂骨折的手术治疗

非相邻节段脊柱骨折 (noncontiguous spinal fractures) 占全部脊柱损伤的1.6%～16.7%[1],而全部发生在腰椎部位少见.国外文献报道,跳跃式腰椎爆裂骨折仅占脊柱损伤的0.8%[2],绝大多数患者为坠落致伤,是一种非常严重的创伤,多合并有不同程度的脊髓损伤,而且脊柱稳定性差,需要手术治疗.目前各家报道手术方法不同[3].我院自1996年1月至2004年1月手术治疗跳跃式腰椎爆裂骨折15例,取得良好效果.现总结分析如下.

Objective:　To study the mechanism and treatment principle of spinal fractures combined with paraplegia and diaphragm injury.　　Methods:　A total of 16 patients (14 males and 2 females, aged from 18 to 50 years) with spinal fractures combined with paraplegia and diaphragm injury, receiving emergency treatment and admitted to our hospital in the past 20 years, were retrospectively analyzed in this study. 　　Results:　The injuries were caused by direct or indirect violence. Six cases were of fractures of cervical spine combined with paraplegia and diaphragm injury, 2 of fractures of thoracic vertebra combined with paraplegia and diaphragm injury, and 8 of thoracolumbar fractures combined with paraplegia and diaphragm injury. Six cases received non-operative treatment, but died finally. Ten cases received spine surgical treatment, of which 4 died and 6 were improved. The total mortality rate was 62.5%. 　　Conclusions:　Spinal fractures combined with paraplegia and diaphragm injury are one of the most severe traumas in departments of orthopaedics. Paraplegia can be found easily, but diaphragm injury is often neglected and missed. When a patient suffers from both of them, he is in danger of death. What measures should be taken to rescue the patients life depends on the severity of the wounds.