Denis F, Burkus J K
Minnesota Spine Center, Fairview-Riverside Hospital, Minneapolis.
Spine (Phila Pa 1976). 1992 Feb;17(2):156-61. doi: 10.1097/00007632-199202000-00007.
Twelve patients sustained a shear fracture-dislocation of their thoracic or lumbar spines by a hyperextension mechanism of injury. Ten male and two female patients were injured; their average age was 29 years (range, 22 months to 56 years). Ten fracture-dislocations occurred in the thoracic spine, one at the thoracolumbar junction, and one in the lumbar spine. Eleven patients had complete paraplegia, and one had incomplete paraplegia at the time of injury. Dural tears were found in six of the patients. Eleven patients were treated by posterior spinal fusion with instrumentation, and one was treated with a brace. Three patients were treated with Harrington distraction rods alone, six had Harrington distraction rods supplemented with a midline Harrington compression rod or interspinous wiring, and two were treated with Cotrel-Dubousset instrumentation. No patient was lost to follow-up. The average length of follow-up was 3.5 years (range, 1-9 years). Six of the patients treated with Cotrel-Dubousset instrumentation or Harrington distraction rods supplemented with either a midline compression rod or interspinous wiring healed anatomically; two patients developed pseudarthroses. None of the patients treated with Harrington distraction rods alone healed in an anatomic position. The use of Harrington distraction rods alone was associated with overdistraction and nonanatomic alignment of the spine. The disruption of the anterior stabilizing structures of the spine associated with hyperextension injuries necessitates the use of instrumentation that can stabilize the spine and prevent overdistraction. This injury can be successfully treated with Cotrel-Dubousset or Harrington distraction rods supplemented with either a midline compression rod or interspinous wiring.
12例患者因脊柱过伸损伤机制导致胸腰椎剪切骨折脱位。受伤患者中男性10例，女性2例；平均年龄29岁（范围为22个月至56岁）。10例骨折脱位发生在胸椎，1例在胸腰段交界处，1例在腰椎。11例患者受伤时出现完全性截瘫，1例为不完全性截瘫。6例患者发现硬脊膜撕裂。11例患者接受了后路脊柱融合内固定治疗，1例采用支具治疗。3例患者仅使用哈灵顿撑开棒治疗，6例使用哈灵顿撑开棒并辅以中线哈灵顿加压棒或棘突间钢丝固定，2例采用 Cotrel-Dubousset 器械固定。无患者失访。平均随访时间为3.5年（范围为1 - 9年）。采用Cotrel-Dubousset器械或辅以中线加压棒或棘突间钢丝固定的哈灵顿撑开棒治疗的患者中有6例实现解剖愈合；2例出现假关节形成。仅使用哈灵顿撑开棒治疗的患者均未在解剖位置愈合。仅使用哈灵顿撑开棒与脊柱过度撑开和非解剖对位有关。与过伸损伤相关的脊柱前方稳定结构破坏需要使用能够稳定脊柱并防止过度撑开的器械。这种损伤可以通过Cotrel-Dubousset或辅以中线加压棒或棘突间钢丝固定的哈灵顿撑开棒成功治疗。
