《中国康复理论与实践》

《中国康复理论与实践》 ›› 2003, Vol. 9 ›› Issue (06): 352-353.

• 临床研究 • 上一篇    下一篇

无神经症状胸腰椎爆裂型骨折的保守治疗

周再正   

  1. 浙江省台州学院医学院 浙江台州市 317000
  • 收稿日期:2003-03-17 出版日期:2003-06-25 发布日期:2003-06-25

Clinical study on thoracolumbar fractures without neurologic deficit treated with nonoperative management

ZHOU Zai-zheng   

  1. Zhejiang Taizhou Medical College,Taizhou 317000,Zhejiang,China
  • Received:2003-03-17 Published:2003-06-25 Online:2003-06-25

PDF (PC)

摘要： 目的探讨无神经症状的胸腰椎爆裂型骨折保守治疗的可行性、临床疗效、适应证及禁忌症。方法选择20例无神经损伤的单节段胸腰椎爆裂型骨折患者,经轴向牵引、充气复位、背伸锻炼、卧床休息等保守治疗,用影像学和 Mumford临床疗效评定标准评定。结果脊柱后突角经Cobb氏法测定,复位前平均为18.5°,复位后平均为8°,椎体前缘高度复位前平均为50.68%,复位后平均为87.18%,复位前后均有高度显著性差异(P<0.01)。12例椎体后缘骨块突入椎管者,治疗前平均占位27%,治疗后椎管面积完全恢复2例,占位面积缩小9例,无变化1例,占位面积平均缩小16%,治疗前后亦有高度显著性差异(P<0.01)。经平均2.5年随访,14例无畸形,无腰背痛;5例间歇性轻度腰背痛,功能不受限,恢复原工作;1例3个月后出现严重腰痛及右下肢疼痛,影响日常活动,施前路减压融合Kaneda内固定术。结论无神经症状的胸腰椎爆裂骨折可以选择保守治疗。

关键词: 爆裂骨折, 胸腰椎, 非手术治疗

Abstract: ObjectiveTo study the clinical outcome and efficacy of closed management of theoracolumbar burst fractures without neurologic deficits.Methods 20 patients with a burst fracture of thoracolumbar vertebrae but without neurologic deficit were reviewed clinically and radiographically following nonoperative management.ResultsAfter treatment, the averaged Cobb angle (8°)was better than that (18.5°) before treatment (P<0.01), and the averaged anterior body height (87.18%) was also better than that (50.68%) before treatment (P<0.01). In 12 patients, averaged occupying area of vertebra in vertebral canal was 27% before treatment and lowered 16% after treatment (P<0.01). During treatment period, one patient developed neurologic deterioration that prompted surgery. All other patients remained neurologically intact. After follow-up (average 2.5 years), an overall outcome evaluation indicated that 70% of patients had excellent outcomes relative to pain and function, 25% had good and 5% had poor outcomes.Conclusions These findings suggest that nonoperative management as the preferred treatment can use in above circumstances.

Key words: burst fracture, thoracolumbar vertebrae, nonoperative management