摘要
对胸腰椎骨折手术适应证的选择应结合临床和影像学检查 ,根据病人脊髓受压和损伤情况及脊柱的稳定性作出决定。保守治疗与预后密切相关。及时进行后凸部位加垫、脊柱牵引的病人常不需手术即能大部分复位 ,早期大剂量甲基强地松龙可有效防止脊髓再灌注损伤 ,促进脊髓休克、脊髓震荡的恢复。后伸支具可以治疗无神经损伤的脊柱骨折 ,但须佩带 6～ 8个月。前路及后路手术各有其适应证 ,应根据骨折部位、受伤时间长短、脊髓受压程度及术者对手术入路的熟悉程度等因素而定。椎弓根钉系统符合脊柱固定的生物力学要求 ,可有效控制三维方向的剪力。在诸多因素中 ,影响内植物应力载荷及稳定性的最大因素是脊柱前中柱的稳定性 ,保持其稳定性是防止内植物固定失败的关键。植骨融合是脊柱骨折的重要治疗原则 ,经椎弓根椎体内植骨是近年应用于临床的新方法 ,虽不能完全防止断钉、断棒等并发症 ,但能增加爆裂椎体内的骨量 ,增加椎体强度 ,防止椎体塌陷及脊柱角状后凸的形成 。
To decide the operative indications of thoracic lumbar vertebral fracture,we should consider the compressed status of spinal cord and stability of spine,combining the result of clinical and image examination. The thoracic lumbar vertebral fracture may often be reducted approximately by putting pad under kyphosis site and performing spine traction,instead of operation. Early a large dosage methylprednisolone can prevent the spinal cord from blood reflow injury and promote nervous function recovery from spinal cord shock or concussion. Extension brace can be used treated spine fracture without nervous function deficit,which must be persisted until posttraumatic 6 8 month. Anterior and posterior approach operation indications are various,which should be chose according the site of fracture,time after injury,compressed status of spinal cord and operator acquaintance with approach. Vertebral pedicle internal fixation system conformed to the mechanic request of spine fixation and controlled the shearing force effectively in three dimension direction. Among those factors effecting the stress load and stability of implant of spine,the most important one is the stability of anterior and middle columns of spine. Therefore,re establishing its stability is the key of avoiding implant failure. Spinal fusion is an important principle of treating spine fracture. A new clinical technique was bone transplant into vertebral body thought vertebral pedicle,which cannot avoid break of screw or rod completely,but can prevent vertebrae form collapse and kyphosis by increasing the quantity of bone and the intensity of injured vertebral body. Of course,its forward effect should be observed furthermore.
出处
《创伤外科杂志》
2003年第4期241-243,共3页
Journal of Traumatic Surgery
关键词
胸腰椎
骨折
thoracic lumbar spine
fracture
