Hermichen H G, Bilow H
Berufsgenossenschaftliche Unfallklinik Tübingen.
Aktuelle Traumatol. 1988 Jul;18 Suppl 1:18-23.
Indications for operative treatment of spinal fractures sometimes are difficult to work out. Undoubtedly deteriorating neurological deficits require decompression always combined with stabilization. Due to new classifications a severe instability of the fracture, an axis deviation more than 25 degrees and polytraumatized patients show up being an indication for operative treatment. A proper preoperative planning with use of X-rays and CT Scan as well as the knowledge of the kind and site of instability is mandatory. In cervical spine fractures anterior fusion seems to be the best method. In thoracic spine fractures dorsally attached plates give enough stability. In the thoraco-lumbar spine region and in the lumbar spine itself the internal fixator with dorsal instrumentation together with a transpedicular bone graft is preferred by the authors. Among 384 fractures of the spine 62 have been operated. Both kinds of treatment do not compete; they are complementary instead.
脊柱骨折手术治疗的适应证有时很难确定。毫无疑问，神经功能缺损恶化时需要减压，且总是要结合稳定手术。由于新的分类方法，骨折严重不稳定、矢状面移位超过25度以及多发伤患者都被视为手术治疗的适应证。术前使用X线和CT扫描进行恰当的规划以及了解不稳定的类型和部位是必不可少的。对于颈椎骨折，前路融合似乎是最佳方法。对于胸椎骨折，后路钢板能提供足够的稳定性。在胸腰段脊柱区域和腰椎本身，作者更倾向于使用后路器械的内固定器并结合经椎弓根植骨。在384例脊柱骨折中，有62例接受了手术治疗。两种治疗方法并非相互竞争，而是相辅相成。
