Liu Yong-Jeng, Chang Ming-Chau, Wang Shih-Tein, Yu Wing-Kuang, Liu Chien-Lin, Chen Tain-Hsiung
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Sec. 2, Shih-Pai Road, Taipei 201, Taiwan, ROC.
Injury. 2003 Dec;34(12):920-3. doi: 10.1016/s0020-1383(02)00396-0.
Flexion-distraction injury of the thoracolumbar spine results from a failure of both the posterior and middle columns under tension, and this injury is uncommon. Progressive kyphotic deformity frequently develops after conservative treatments. We report our 10 years' experience with the surgical treatment of flexion-distraction injuries. From January 1991 to December 2000, 30 flexion-distraction thoracolumbar spinal injuries were treated at our hospital. We included 23 patients in this study, and seven patients were excluded. The mean age of the patients was 37.2 years. Six were female and 17 were male. All patients received open reduction, posterior instrumentation, and posterior fusion at the level of injury. Post-operatively, patients were all placed in total contact orthoses for 3 months. Ambulation was allowed immediately after brace application.The mean follow-up period was 84.7 months follow-up. The final average follow-up kyphotic angulation was 5.4 degrees, which is an average improvement of 9.5 degrees. Post-operative back pain ratings indicated that result of surgery was mostly good, and the neurological evaluation was almost normal after long-term follow-up. A satisfactory reduction and good stabilisation with solid fusion was achieved in all cases, without any significant loss of reduction. Surgical treatment of reduction and stabilisation with posterior instrumentation and fusion is suggested in patients with flexion-distraction injury of the thoracolumbar spine.
胸腰椎的屈曲-牵张损伤是由于后柱和中柱在张力作用下失效所致，这种损伤并不常见。保守治疗后常出现进行性后凸畸形。我们报告了我们在屈曲-牵张损伤手术治疗方面的10年经验。从1991年1月至2000年12月，我院共治疗了30例胸腰椎屈曲-牵张损伤。本研究纳入23例患者，排除7例患者。患者的平均年龄为37.2岁。女性6例，男性17例。所有患者均接受切开复位、后路内固定及损伤节段的后路融合术。术后，患者均佩戴全接触矫形器3个月。佩戴支具后立即允许行走。平均随访期为84.7个月。最终平均随访时的后凸角度为5.4度，平均改善了9.5度。术后背痛评分表明手术结果大多良好，长期随访后神经学评估几乎正常。所有病例均实现了满意的复位和良好的稳定，且融合牢固，无明显复位丢失。对于胸腰椎屈曲-牵张损伤患者，建议采用后路内固定和融合术进行复位和稳定治疗。
