Gu Yong-Jie, Hu Yong, Xu Rong-Ming, Ma Wei-Hu
Department of Spinal Surgery, the Sixth Hospital of Ningbo, Ningbo 315040, Zhejiang, China.
Zhongguo Gu Shang. 2009 Nov;22(11):838-40.
To explore the surgical treatment and classification of multiple-level noncontiguous thoracolumbar fractures.
From December 2005 to December 2008, 24 patients with multiple-level noncontignous thoracolumbar fractures were treated by surgical operation included 16 males and and 8 females with a mean age of 36 years old ranging from 18 to 63 years. According to the ASIA grade of spinal nerve function there was 1 case in grade A, 2 cases in grade B, 2 cases in grade C, 8 cases in grade D and 11 cases in grade E. Based on the modified classification of multiple-level noncontiguous spinal fractures (MNSF) there were 15 cases of type A,9 of type B. The fracture involved 48 vertebraes ranged from T6 to L4. Radiographic data were analyzed retrospectively.
All patients achieved surgical treatment without missed diagnosis or delayed diagnosis. All cases were followed up for from 3 to 36 months (means 18.3 months). All cases achieved bone fusion, without significantly lose of the vertebrae body height and implant failure. Among 13 patients with spinal nerves injuries before operation, 11 got more than one grade improvement of the ASIA grading, 2 remained unchanged.
The traditional classification methods are improved to guide treatment. The treatment of multiple-level noncontiguous thoracolumbar fractures should be determined according to the severity of spinal cord injury, the stability and the types of spine fractures.
探讨多节段非连续性胸腰椎骨折的手术治疗及分类。
2005年12月至2008年12月，对24例多节段非连续性胸腰椎骨折患者行手术治疗，其中男性16例，女性8例，平均年龄36岁（18～63岁）。根据脊髓神经功能的ASIA分级，A级1例，B级2例，C级2例，D级8例，E级11例。根据改良的多节段非连续性脊柱骨折（MNSF）分类，A型15例，B型9例。骨折累及48个椎体，范围从T6至L4。对影像学资料进行回顾性分析。
所有患者均获得手术治疗，无漏诊或延迟诊断。所有病例均随访3～36个月（平均18.3个月）。所有病例均实现骨融合，椎体高度无明显丢失，内固定无失败。术前13例脊髓神经损伤患者中，11例ASIA分级提高1级以上，2例无变化。
对传统分类方法进行改良以指导治疗。多节段非连续性胸腰椎骨折的治疗应根据脊髓损伤的严重程度、脊柱骨折的稳定性及类型来确定。
