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Surgical Treatment in Thoracolumbar and Lumbar Burst Fractures - Report of 157 Cases

胸腰椎及腰椎爆裂性骨折之外科治療

Abstracts


從民國七十一年六月到七十八年五月,七年期間,共有157位病患因腰椎或胸腰椎爆裂性骨折接受手術治療。其中124位接受後位手術,33位接受前位或前後位手術。後位手術中有114位病患為接受哈林頓內固定術方法。手術適應症為不穩定爆裂性骨折或合拼漸進性脊椎功能缺損。前位手術之適應症為不完全神經功能缺損且合併管腔受壓迫程度超過百分之五十。後位手術術後再接受前位手術的適應症為術後脊椎管腔仍小於1公分或管腔內有游離性碎骨或前面的椎體有缺損現象。病患平均年齡為35.6歲(從14到60歲不等)。128位病患接受追蹤檢查,追縱時間平均為三年(由1年到8.3年不等),百分之六十二的受傷原因為高處跌落。較常受傷處為第一腰椎(佔百分之四十五)。依丹尼斯氏分類,b類骨折(九十位病人)佔百分之七十一。位院時神經學檢查發現百分之四十二病患受傷時呈現混合式髓椎(conus medullaris)及馬尾部之損傷,其中百分之四十一在追蹤時已完全回復括約肌功能;另外二十二位病患受傷時呈現單純性馬尾部損傷,其中百分之六十六在追蹤時已完全回復括約肌功能。受傷前,立即後及追縱時的背凸程度(kyphosis)為20.55°±9.96°,8.58°±8.99°及11.25°±8.14°。平均來說,百分之五十七的後位手術病患及百分之八十二的前位及合併前後位手術病患於追蹤時,依Frankel 氏標準來算至少都進步一級以上66位病患在受傷時為無法行走的情況,其中24位在追蹤時已可獨立行動。

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Parallel abstracts


Between June 1982 and May 1989, 157 patients with thoracolumbar and lumber burst fractures were operated on at Chang Gung Memorial Hospital. Among them, 114 of 124 patients undergoing posterior surgery were Harrington-rod stabilization; 33 patients underwent anterior or combined anterior and posterior surgery. The indications for surgery were unstable burst fracture and / or with progressive neurologic deficit. The surgical approaches were either posterior only, posterior surgery followed by anterior surgery, or anterior surgery with or without posterior surgery. The indication for anterior surgery first is incomplete neurologic deficit with neural canal encroachment more than 50%. The indications of anterior surgery after the posterior surgery are canal size smaller than 1cm, free fragments within the canal or marked osseous defect of the vertebral body anteriorly. The average age of patients at the time of injury was 35.6 years (range 14 to 60 years). One hundred and twenty-eight patients have been followed for an average of 3 years (range one to 8.3 years). Sixty-two per cent of the injuries were the result of a fall from height. The most common site of injury was at L1(45%). By denis’ classification, type B fracture (90 patients) accounted for 71% of the injuries. Of the 42% of patients presenting with mixed conus medullaris and cauda equine lesions, 41% had complete recovery of bowel and bladder function at follow-up. Twenty-two percent of patients had pure cauda equiina lesions at initial jnjury, and 66% of them had return of sphincter function. The average kyphosis angle at preoperation, immediate postoperation and at follow-up were 20.55°±9.96°, 8.58°±8.99°and 11.25°±8.14°. Overall, 57% of the patients in the posterior surgery group and 82% in the anterior or combined anterior and posterior surgery group showed an average neurologic recovery of more than one grade on the Frankel scale. Sixty-six patients presented neurological functions at or less than Frankel c (the non-ambulatory group); 24 became independent walkers during the follow-up period.

Parallel keywords

burst fracture surgery

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