对象。据报道,胸部骨折脱位导致80%的病例完全截瘫。这些脱位不引起神经功能缺损的情况非常罕见,英语文献中仅有11例完整的神经系统病例证明了这一点。
开云体育世界杯赔率方法。作者报告了4例神经系统完整的胸椎骨折脱位,并讨论了其他11例先前发表的文献完备的病例。
总共有10名男性和5名女性,平均年龄34岁(17-66岁)。受伤机制包括6例车祸,7例摩托车事故,1例飞机事故,1例从马上摔下。入院时,11例患者无神经功能缺损,2例存在肋间神经痛,2例表现为轻度下肢无力/麻木。所有患者都有明显的胸痛,14名患者有持续性肋骨骨折,8名患者有胸血。脱位程度为T3-4例,T5-6例,T6-7例,T7-8例,T8-9例,T9-10例。所有患者均有一定程度的侧移(平均12mm,范围3 - 27mm)。除移位外,有6例前路半脱位(平均12毫米,范围4-23毫米),均涉及一个椎体(VB)向相邻椎体(VB)发生一定程度的骨折内爆。爆裂性骨折伴移位6例(平均后凸角度38°,范围28 ~ 50°)。所有15例患者在半脱位部位均出现双侧椎弓根剪力骨折,从而使前后椎弓根分离并保留椎管。15例患者中只有2例发生了完全的脊柱滑脱。 Five patients underwent successful nonoperative management with prolonged bed rest; at follow-up examination, neurological status remained normal in all five, lesions were radiographically unchanged in three, and there was less subluxation but not anatomical alignment in two. Ten patients underwent successful internal fixation via anterior approaches (two cases), posterior approaches (five cases), and combined approaches (three cases). Neurological status either improved to normal or remained normal except in one case with persistent intercostal neuralgia. Surgery resulted in no change in alignment in three, improved but not anatomical alignment in 11, and normal alignment in one patient. All patients ambulated unassisted by 6 months.
结论。如果双侧椎弓根骨折发生在明显的胸椎半脱位和/或移位部位,当椎板和脊髓不随前椎弓根移位时,很少能保留椎管和脊髓神经功能。在这些情况下,完美的解剖复位可能需要力量,不必要地使神经功能处于危险之中,结果似乎证明了内固定可以部分或不复位畸形。