摘要
目的探讨胸腰椎损伤分类及损伤程度评分系统(thoracolumbar injury classification and severity score,TLICS)在胸腰椎骨折手术入路的指导作用的疗效。方法 2006年10月至2010年9月采用收治胸腰椎骨折患者31例。男20例,女11例,年龄35～56岁,平均44.7岁。T113例,T126例,L17例,L28例,L37例。受伤至手术时间7h～11d,平均6d。高处跌伤21例,交通伤10例。所有患者术前术后随访时分别拍摄胸腰椎正侧位片、三维CT重建、MRI观察椎体粉碎和神经受压情况。骨折按Magerl分型:A3型8例,B1型8例,B2型9例,C1型3例,C2型3例。神经功能按Frankel分级,A级4例,B级8例,C级9例,D级6例,E级4例。后路手术11例,前路手术12例,前后路手术8例。结果术后28例获得随访,随访时间12～17个月,平均13.7个月,术前骨折处后凸角度(23.7±11.3)°(13°～38°),术后骨折处后凸角度(5.8±0.6)°(-4°～6°),最后随访后凸(0.9±10.6)°。平均手术时间190min(90～380min),平均出血量1680ml(1260～2540ml),平均住院17.4d(10～24d)。术后神经功能损伤Frankel评分有1级以上的恢复,在最后的随访中没有发现内固定松动移位。结论采用胸腰椎损伤分类及损伤评分系统指导胸腰椎骨折手术入路治疗效果好。
Objective To analyze the thoracolumbar injury classification and severity score（TLICS） in the choice of anterior , posterior or combined surgery for thoracolumbar fractures. Methods From November 2006 to September 2010,31 consecutive patients with acute thoracolumbar burst fractures who were treated in an our unit were evaluated. There were 20 male and 11 female patients in this group. The mean age was 44. 7 years （range ,35 -56 years）. The fractures were located at Tll in 3, T12 in 6,L1 in 7, L2 in 8,and L3 in 7. The mechanisn of injury was motor vehicle accident in 10 of the patents, fall from a height in 24. All patients had preoperative anteroposterior and lateral radiographs, computed tomography （CT） scan, and magnetic resonance imaging （MRI） examination to more fully assess vertrbral comminution and nerve compresssion. According to the classification of Magerl ,there were 8 eases of type A3,8 cases of B1,9 eases of B2,3 eases of C1,3 case of C2. Neurologic status based on Frankel classification was at grade A in four patients, grade B in eight , grade C in 9, grade D in six and grade E in four. Of the 31 patients, 11 received posterior surgeries , 12 anterior surgeries, and 8 combined anterior and posterior surgeries. Results All patients observed for a minimum of 2 years with a mean follow-up period of 13.7 months（ range, 12 - 17 months）. The kyphosis angle was measured from the supe- rior endplate to the inferior end plate of the fractured vertebral body using the Cobb technique. The mean cobb＇ s angle was （ 23.7 ± 11.3 ） ° （ range , 13°- 38 o ） preoperatively , （ 5.8 ± 0. 6） ° （ -4° ± 6 ° ） lordotic post opera- tively and （0. 9 ± 10. 6 ） °lordotic at the final observation. The mean surgical time was 190 minutes （range,90 - 380 minutes） ,mean blood loss was 1680 ml （range, 1260 ±2540 ml） , and mean hospital stay was 17.4 days （range , 10-24 days）. No evidence of instrumentation failure such as instrumentation loosening or motion was observed in the final follow-up radiographuy and and CT images. Condusion TLICS has facilitate treatment decision making of thoracolumbar spinal column injuries, was proved to be an effective treatment for serious thoracolumbar fracture.
出处
《中国现代药物应用》
2012年第24期4-6,共3页
Chinese Journal of Modern Drug Application
关键词
脊柱骨折
胸椎
腰椎
手术入路
Spinal fractures
Thoracic vertebrae
Lumbar vertebrae
Surgical approach
