胸腰椎骨折损伤分类的临床研究
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摘要
随着现代生产生活节奏的加快,脊柱脊髓的损伤日趋常见。其中胸腰段骨折发生率最高,胸腰段脊柱一般胸11~腰2节段脊柱,该节段脊柱脊髓损伤称为胸腰段脊柱脊髓损伤。由于脊柱脊髓损伤的较为复杂、检查条件的不一并且研究侧重点的多样,至今尚无公认的胸腰椎损伤的统一分类方法。任何一种的胸腰段骨折分类系统都存在不足之处,不能解决所有的临床问题。本文通过回顾性研究2007年3月至2009年11月治疗的创伤胸腰段骨折患者94例,通过查阅相关病历资料了解术前症状,包括疼痛,脊柱功能以及神经症状,行腰椎JOA评分并记录其结果。通过电话,门诊等随访方式记录患者治疗后治疗后恢复情况,包括疼痛,脊柱屈伸运动功能,以及神经症状,再行腰椎JOA评分并记录。通过统计学分析胸腰段骨折损伤在不同分类系统下的治疗方法以及疗效评价,为临床治疗方案的制定和实施提供依据,并且提出了新的分类系统。
Background and objective: Thoracolumbar injury and fracture is the most common spinal injury. Thoracolumbar injury is the injury from T11 to L2 segment. It is about 62.4% of the whole thoracic and lumbar spine injury .Injury of T12 and L1 is about 44.8%.The high incidence of thoracolumbar injury have much to do with the anatomy of thoracolumbar . The activity of thoracic spine is relatively small, while the relatively large degree of lumbar. Thoracolumbar segment is the junction of both sides. It is the transition point of activity level of the spine area. Such fractures occurred mostly in young adults, high-energy injury is a major causative factor. But the treatment of thoracolumbar fractures has long been a big controversy. The reason was mainly due to the current classification of thoracolumbar spine injury and scoring system evaluation is uneven, and can not be a good guide towards thoracolumbar injury diagnosis and treatment. At present AO and Denis classification system is the most commonly used classification system for thoracolumbar spine. In 2005 ,the U.S. team has developed a set of spinal injuries of thoracolumbar scoring system, and called the thoracolumbar injury classification and scoring system (Thoracolumbar Injury Classification and Severity Score, TLICS). At present the main arguments of the treatment of thoracolumbar fractures are: (1) surgical or non-surgical treatment; (2) treatment of anterior or posterior or combined approach to treat; (3) long-segment or short segment fixation. This study is intended that using Denis, AO, and TLICS classification systems for pathological retrospective study .Try to find relationship of fracture classification and treatment. We also look forward to investigate the problems of treating thoracolumbar fracture discussed above and provide the basis for the formulation and implementation for clinical treatment programs.
Method: Collect 301 cases of thoracolumbar fracture patients treated in China-Japan Union Hospital Jilin University from March 2007 to November 2009.we try to gather the imaging data of 301 cases of patients. we obtain 141 cases. We investigate the method of treatment and follow-up effect of the treatment through telephone and outpatient service. Finally,a complete follow-up of 94 cases were finished.of Access to relevant medical information about preoperative symptoms, including pain, spinal function and neurological symptoms. use lumbar JOA score and record the results. Phone, out-patient follow-up is carried out to record recovering condition after treatment, including pain, spinal flexion and extension motor function neurological symptoms and using lumbar JOA score and recorded them . we conducted a retrospective study of cases, intending to analysis and evaluate the effect of the treatment methods in different thoracolumbar fracture classification system through the statistical study.
Result: morphological analyzing of 94 cases, there is no significant difference between surgical treatment and non-surgical treatment (P> 0.05) in compression fracture of Denis classification and the A1.1 and A1.2 fractures of the AO classification.
There is statistical significant difference between the non-surgical treatment and surgical treatment (P <0.05) in Burst fractures of Denis classification and A3.1 type fracture of AO classification. While treating with long segment and short-segment ,there are also significant difference (P <0.05).
Flexion-distraction and dislocation injury of Denis classification and B, C-type injuries of AO classification of of at least two columns combined injury,there is statistical significant difference (P <0.05)between non-surgical treatment and surgical treatment, and Long-segment fixation should be recommended.
The patients whose TLICS score less than 3, there is no significant difference (P> 0.05)between the surgical treatment and non-surgical treatment. The result is the same as standards given by the Spine Trauma Study Group.
The patients whose TLICS score more than 5, there is significant difference (P> 0.05)between the surgical treatment and non-surgical treatment. The result is the same as standards given by the Spine Trauma Study Group.
There are 13 cases patients whose TLICS score are 4 points, non-surgical treatment of 5 cases, surgical treatment of 8 cases . The followed up improvement rate of non-surgical is (41.8±7.4)%,the improvement rate of surgical treatment is (72.4±6.7)%. There is Statistical significant difference between the two proups (P <0.05). The follow up improvement rate of non-surgical group is 40%, 30.8%, 38.5%, 50%, 46.2%, improvement rate is between 25 ~ 60% .The effectiveness is moderate. There are two of which appear in pain, three cases of limitation of spinal activities which combined with difficulties od anterocollis in daily life . The patients whose TLICS scores are 4 points , most of them without neurological symptoms.The majority fracture type are burst fracture in Denis classification and A3.1 in AO classification.It is to be noted they may combine with the PLC injury. We can reconstruction spinal stability and repair posterior ligament through surgical treatment. Therefore ,we also can reduce the long-term complications and improve quality of life.
Through case analysis, we establish a new classification system of thoracolumbar fractures based on Ferguson's three-column concept.
Conclusion: We establish a new classification system of thoracolumbar fractures . The general principles for treatment is: Type A and B injury are stable, which should recept conservative treatment; Type C injury surgical treatment is superior to non-surgical treatment. short-segment posterior pedicle screw fixation is recommended. Type D, E injury should be used long-segment posterior pedicle screw fixation.
Background and objective: Thoracolumbar injury and fracture is the most common spinal injury. Thoracolumbar injury is the injury from T11 to L2 segment. It is about 62.4% of the whole thoracic and lumbar spine injury .Injury of T12 and L1 is about 44.8%.The high incidence of thoracolumbar injury have much to do with the anatomy of thoracolumbar . The activity of thoracic spine is relatively small, while the relatively large degree of lumbar. Thoracolumbar segment is the junction of both sides. It is the transition point of activity level of the spine area. Such fractures occurred mostly in young adults, high-energy injury is a major causative factor. But the treatment of thoracolumbar fractures has long been a big controversy. The reason was mainly due to the current classification of thoracolumbar spine injury and scoring system evaluation is uneven, and can not be a good guide towards thoracolumbar injury diagnosis and treatment. At present AO and Denis classification system is the most commonly used classification system for thoracolumbar spine. In 2005 ,the U.S. team has developed a set of spinal injuries of thoracolumbar scoring system, and called the thoracolumbar injury classification and scoring system (Thoracolumbar Injury Classification and Severity Score, TLICS). At present the main arguments of the treatment of thoracolumbar fractures are: (1) surgical or non-surgical treatment; (2) treatment of anterior or posterior or combined approach to treat; (3) long-segment or short segment fixation. This study is intended that using Denis, AO, and TLICS classification systems for pathological retrospective study .Try to find relationship of fracture classification and treatment. We also look forward to investigate the problems of treating thoracolumbar fracture discussed above and provide the basis for the formulation and implementation for clinical treatment programs.
Method: Collect 301 cases of thoracolumbar fracture patients treated in China-Japan Union Hospital Jilin University from March 2007 to November 2009.we try to gather the imaging data of 301 cases of patients. we obtain 141 cases. We investigate the method of treatment and follow-up effect of the treatment through telephone and outpatient service. Finally,a complete follow-up of 94 cases were finished.of Access to relevant medical information about preoperative symptoms, including pain, spinal function and neurological symptoms. use lumbar JOA score and record the results. Phone, out-patient follow-up is carried out to record recovering condition after treatment, including pain, spinal flexion and extension motor function neurological symptoms and using lumbar JOA score and recorded them . we conducted a retrospective study of cases, intending to analysis and evaluate the effect of the treatment methods in different thoracolumbar fracture classification system through the statistical study.
Result: morphological analyzing of 94 cases, there is no significant difference between surgical treatment and non-surgical treatment (P> 0.05) in compression fracture of Denis classification and the A1.1 and A1.2 fractures of the AO classification.
There is statistical significant difference between the non-surgical treatment and surgical treatment (P <0.05) in Burst fractures of Denis classification and A3.1 type fracture of AO classification. While treating with long segment and short-segment ,there are also significant difference (P <0.05).
Flexion-distraction and dislocation injury of Denis classification and B, C-type injuries of AO classification of of at least two columns combined injury,there is statistical significant difference (P <0.05)between non-surgical treatment and surgical treatment, and Long-segment fixation should be recommended.
The patients whose TLICS score less than 3, there is no significant difference (P> 0.05)between the surgical treatment and non-surgical treatment. The result is the same as standards given by the Spine Trauma Study Group.
The patients whose TLICS score more than 5, there is significant difference (P> 0.05)between the surgical treatment and non-surgical treatment. The result is the same as standards given by the Spine Trauma Study Group.
There are 13 cases patients whose TLICS score are 4 points, non-surgical treatment of 5 cases, surgical treatment of 8 cases . The followed up improvement rate of non-surgical is (41.8±7.4)%,the improvement rate of surgical treatment is (72.4±6.7)%. There is Statistical significant difference between the two proups (P <0.05). The follow up improvement rate of non-surgical group is 40%, 30.8%, 38.5%, 50%, 46.2%, improvement rate is between 25 ~ 60% .The effectiveness is moderate. There are two of which appear in pain, three cases of limitation of spinal activities which combined with difficulties od anterocollis in daily life . The patients whose TLICS scores are 4 points , most of them without neurological symptoms.The majority fracture type are burst fracture in Denis classification and A3.1 in AO classification.It is to be noted they may combine with the PLC injury. We can reconstruction spinal stability and repair posterior ligament through surgical treatment. Therefore ,we also can reduce the long-term complications and improve quality of life.
Through case analysis, we establish a new classification system of thoracolumbar fractures based on Ferguson's three-column concept.
Conclusion: We establish a new classification system of thoracolumbar fractures . The general principles for treatment is: Type A and B injury are stable, which should recept conservative treatment; Type C injury surgical treatment is superior to non-surgical treatment. short-segment posterior pedicle screw fixation is recommended. Type D, E injury should be used long-segment posterior pedicle screw fixation.
引文
[1] Mclain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures·Spine(J),2006,31(11):70-79.
[2]. Mitcho , Karen RN. Acute Care Management of Spinal Cord Injuries. Critical Care Nursig Quarterly,1999,22(2):60-79.
[3]. Charles L, Schnee, Lee V, Ansell. Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit.J-Neurosurg. 1997,86(1):48-55.
[4]. Cohisy JC, Akbarnia BA, Bucholz RD, et al. Neurologic recovery Associated with anterior decompression of spine fractures at the thoracolumbar junction(T12-11). Spine.992,1(suppl 20):S325-S330.
[5]. Bohler L. Die techniek deknochenbruchbehandlung imgrieden undimkreigen[ in German].Verlag von Wilhelm Maudrich, 1930
[6]. Nicoll EA. Fracture of the dorso-lumbar spine. J Bone Joint Surg(Br) , 1949 ,31 : 376-394.
[7]. Holdsworth FW. Fractrures , dislocations , and fracture-dislocations of the spine. J Bone Joint Surg(Br) ,1963 ,45 : 6-20.
[8]. Louis R. Instability theories [ in French] . Rev Chir Orthop, 1977, 63 :423-425.
[9]. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine, 1983, 8( 8) : 817-831.
[10]. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3: 184-201.
[11]. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine, 1994, 19( 15) : 1741-1744.
[12]. Gertzbein SD. Classification of thoracic and lumbar fractrues. Spine,1994, 19( 5) : 626-628.
[13]. McAfee PC , Yuan HA , Fredrickson BE , et al . The value of computed tomography in thoracolumbar fractures. an analysis of one hundred consecutive cases and a new classi- fication. J Bone Joint Surg(Am) , 1983 , 65 :461-473.
[14].张光铂,李子荣,张雪哲.胸腰椎损伤的综合分类与治疗.中华外科杂志, 1989, 27:71-74.
[15].饶书诚.胸腰椎损伤的主要类型.见:饶书诚.脊柱外科手术学.北京:人民卫生出版社, 1993. 202-206.
[16].金大地,杨守铭,于娜沙,等.胸腰椎骨折分类及病理形态特点.中华外科杂志, 2000, 38( 9) : 811-814.
[17]. Vaccaro AR,Lehman RA Jr,Hurlbut RJ,et a1.A new classification of thoracolumbar injuries:the importance of injury norphology,the integrity of the posterior ligamentous complex,and neurologic status[J].Spine,2005,30(20):2325—2333.
[18]. Kelly RP, Whitesides TE Jr. Treatment of lumbodorsal fracture-dislocations. Ann Surg 1968;167:705–717.
[19]. White AA, Panjabi MM. Clinical Biomechanics of the Spine. Philadelphia: Lippincott, 1978.
[20]. Blauth M,Bastian L,Knop C,et a1.Inter-observer reliability in the classification of thoracolumbar spinal injuries[J].Orthopade,1999,28(8):662—681.
[21] .Oner FC,Ramos LM,Simmermacher RK,et a1.Classification of thoracic and lumbar spine fractures:problems of reproducibility.A study of 53 patients using CT and MRI[J].Eur Spine J,2002,11(3):235—245
[22].Kirkham B. Wood, Gaurav Khanna, et al. Assessment of Two Thoracolumbar Fracture Classification Systems as Used by Multiple Surgeons. JBone Joint Surg Am. 2005;87: 1423-1429.
[23].孙天胜,张志成.胸腰椎损伤分类及损伤程度评分系统的评估及初步应用[J].脊柱外科杂志.2007, 5(6):325-329.
[1]. Bohler L.Die techniek deknochenbruchbehandlung imgrieden undimkreigen [ in German]. Verlag von Wilhelm Maudrich, 1930
[2]. Nicoll EA. Fracture of the dorso-lumbar spine. J Bone Joint Surg(Br) ,1949 ,31 :376-394.
[3]. Holdsworth FW. Fractrures , dislocations , and fracture-dislocations of the spine. J Bone Joint Surg(Br) ,1963 ,45 : 6-20.
[4]. Louis R. Instability theories [ in French] . Rev Chir Orthop, 1977, 63 :423-425.
[5]. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine, 1983, 8( 8) : 817-831.
[6]. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3: 184-201.
[7]. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine, 1994, 19( 15) : 1741-1744.
[8]. Gertzbein SD. Classification of thoracic and lumbar fractrues. Spine,1994, 19( 5) : 626-628.
[9]. McAfee PC , Yuan HA , Fredrickson BE , et al . The value of computed tomography in thoracolumbar fractures. an analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg(Am) , 1983 , 65 :461-473.
[10].张光铂,李子荣,张雪哲.胸腰椎损伤的综合分类与治疗.中华外科杂志, 1989, 27: 71-74.
[11].饶书诚.胸腰椎损伤的主要类型.见:饶书诚.脊柱外科手术学.北京:人民卫生出版社, 1993. 202-206.
[12].金大地,杨守铭,于娜沙,等.胸腰椎骨折分类及病理形态特点.中华外科杂志, 2000, 38( 9) : 811-814.
[13]. Vaccaro AR,Lehman RA Jr,Hurlbut RJ,et a1.A new classification of thoracolumbar injuries:the importance of injury norphology,the integrity of the posterior ligamentous complex,and neurologic status[J].Spine,2005,30(20):2325—2333.
[14]. James KS ,Wenger KH , Schlegal JD ,et al. Biomechanical evaluation of the stability of thoracolumbar burst fractures. Spine, 1994 , 19(15) :1731-1740.
[15].Cantor JB ,Lebwohl NH , Garvey T ,et al. Nonoperative managementof stable thoracolumbar burst fractures with early ambulation andbracing. Spine ,1993 ,18 (9) :971-976.
[16]. Weinstein JN ,Collalto P ,Lehmann TR. Thoracolumbar“burst”frac2tures treated conservatively :A long2term follow2up. Spine , 1988 , 13(1) :33-38.
[17]. Oxland TE , Panjabi MM ,Southern EP ,et al. An anatomic basis for spinal instability : A porcine trauma model. J Orthop Res , 1991 , 9 :452-462.
[18]. Hashimoto T , Kandea K,Abumi K. Relationship between traumatic spinal canal stensis and neurologic deficits in thoracolumbar burst fracture. Spine ,1988 ,13 (12) :126821278.
[19]. Bedbrook GM. Treatment of thoracolumbar dislocation and fractures with paraplegia. Clin Orthop ,1975 ,112 :27-43.
[20] Roy-Camille R, Saillant G,Mazel C.Plating of thoracic thoracolumbar and lumbar injuries with pedicle screw plates. Orthop Clin North Am,1986,17(1):147-160.
[21].Tezeren G,kuru I.Posterior fixation of thoracolumbar burst fracture short-segment pedicle fixation versus long-segment instrumentation.Journal of Spinal Disorders &Techniques,2005,18(6):485-488..
[22]. VerlaanJJ,et al.Surgical treatment of traumatic fractures of the thoracic and lumbar spine-A systematic review of the literature on techniques,complications,and outcome. Spine,2004.,29(7):803-814.
[23]邱勇,朱泽章,王斌,吕锦瑜,俞杨,等.钉钩联合使用预防胸腰椎骨折术后纠正丢失的远期临床效果.中华创伤杂志,2003,12(5):742-745.
[24]. Muller U,Berlemann U, Sledge J, et al.Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stablization with monosegmental fution[J].Eur Spine,1999,8:284-289.
[25]. Bridwell KH, Dewald RL.Spinal.Surgery[M].2 nd ed.Philadelphia (NY):Kippincott Raven Publishers, 1997,1839-1880.
[2]. Mitcho , Karen RN. Acute Care Management of Spinal Cord Injuries. Critical Care Nursig Quarterly,1999,22(2):60-79.
[3]. Charles L, Schnee, Lee V, Ansell. Selection criteria and outcome of operative approaches for thoracolumbar burst fractures with and without neurological deficit.J-Neurosurg. 1997,86(1):48-55.
[4]. Cohisy JC, Akbarnia BA, Bucholz RD, et al. Neurologic recovery Associated with anterior decompression of spine fractures at the thoracolumbar junction(T12-11). Spine.992,1(suppl 20):S325-S330.
[5]. Bohler L. Die techniek deknochenbruchbehandlung imgrieden undimkreigen[ in German].Verlag von Wilhelm Maudrich, 1930
[6]. Nicoll EA. Fracture of the dorso-lumbar spine. J Bone Joint Surg(Br) , 1949 ,31 : 376-394.
[7]. Holdsworth FW. Fractrures , dislocations , and fracture-dislocations of the spine. J Bone Joint Surg(Br) ,1963 ,45 : 6-20.
[8]. Louis R. Instability theories [ in French] . Rev Chir Orthop, 1977, 63 :423-425.
[9]. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine, 1983, 8( 8) : 817-831.
[10]. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3: 184-201.
[11]. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine, 1994, 19( 15) : 1741-1744.
[12]. Gertzbein SD. Classification of thoracic and lumbar fractrues. Spine,1994, 19( 5) : 626-628.
[13]. McAfee PC , Yuan HA , Fredrickson BE , et al . The value of computed tomography in thoracolumbar fractures. an analysis of one hundred consecutive cases and a new classi- fication. J Bone Joint Surg(Am) , 1983 , 65 :461-473.
[14].张光铂,李子荣,张雪哲.胸腰椎损伤的综合分类与治疗.中华外科杂志, 1989, 27:71-74.
[15].饶书诚.胸腰椎损伤的主要类型.见:饶书诚.脊柱外科手术学.北京:人民卫生出版社, 1993. 202-206.
[16].金大地,杨守铭,于娜沙,等.胸腰椎骨折分类及病理形态特点.中华外科杂志, 2000, 38( 9) : 811-814.
[17]. Vaccaro AR,Lehman RA Jr,Hurlbut RJ,et a1.A new classification of thoracolumbar injuries:the importance of injury norphology,the integrity of the posterior ligamentous complex,and neurologic status[J].Spine,2005,30(20):2325—2333.
[18]. Kelly RP, Whitesides TE Jr. Treatment of lumbodorsal fracture-dislocations. Ann Surg 1968;167:705–717.
[19]. White AA, Panjabi MM. Clinical Biomechanics of the Spine. Philadelphia: Lippincott, 1978.
[20]. Blauth M,Bastian L,Knop C,et a1.Inter-observer reliability in the classification of thoracolumbar spinal injuries[J].Orthopade,1999,28(8):662—681.
[21] .Oner FC,Ramos LM,Simmermacher RK,et a1.Classification of thoracic and lumbar spine fractures:problems of reproducibility.A study of 53 patients using CT and MRI[J].Eur Spine J,2002,11(3):235—245
[22].Kirkham B. Wood, Gaurav Khanna, et al. Assessment of Two Thoracolumbar Fracture Classification Systems as Used by Multiple Surgeons. JBone Joint Surg Am. 2005;87: 1423-1429.
[23].孙天胜,张志成.胸腰椎损伤分类及损伤程度评分系统的评估及初步应用[J].脊柱外科杂志.2007, 5(6):325-329.
[1]. Bohler L.Die techniek deknochenbruchbehandlung imgrieden undimkreigen [ in German]. Verlag von Wilhelm Maudrich, 1930
[2]. Nicoll EA. Fracture of the dorso-lumbar spine. J Bone Joint Surg(Br) ,1949 ,31 :376-394.
[3]. Holdsworth FW. Fractrures , dislocations , and fracture-dislocations of the spine. J Bone Joint Surg(Br) ,1963 ,45 : 6-20.
[4]. Louis R. Instability theories [ in French] . Rev Chir Orthop, 1977, 63 :423-425.
[5]. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine, 1983, 8( 8) : 817-831.
[6]. Magerl F, Aebi M, Gertzbein SD, et al. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J, 1994, 3: 184-201.
[7]. McCormack T, Karaikovic E, Gaines RW. The load sharing classification of spine fractures. Spine, 1994, 19( 15) : 1741-1744.
[8]. Gertzbein SD. Classification of thoracic and lumbar fractrues. Spine,1994, 19( 5) : 626-628.
[9]. McAfee PC , Yuan HA , Fredrickson BE , et al . The value of computed tomography in thoracolumbar fractures. an analysis of one hundred consecutive cases and a new classification. J Bone Joint Surg(Am) , 1983 , 65 :461-473.
[10].张光铂,李子荣,张雪哲.胸腰椎损伤的综合分类与治疗.中华外科杂志, 1989, 27: 71-74.
[11].饶书诚.胸腰椎损伤的主要类型.见:饶书诚.脊柱外科手术学.北京:人民卫生出版社, 1993. 202-206.
[12].金大地,杨守铭,于娜沙,等.胸腰椎骨折分类及病理形态特点.中华外科杂志, 2000, 38( 9) : 811-814.
[13]. Vaccaro AR,Lehman RA Jr,Hurlbut RJ,et a1.A new classification of thoracolumbar injuries:the importance of injury norphology,the integrity of the posterior ligamentous complex,and neurologic status[J].Spine,2005,30(20):2325—2333.
[14]. James KS ,Wenger KH , Schlegal JD ,et al. Biomechanical evaluation of the stability of thoracolumbar burst fractures. Spine, 1994 , 19(15) :1731-1740.
[15].Cantor JB ,Lebwohl NH , Garvey T ,et al. Nonoperative managementof stable thoracolumbar burst fractures with early ambulation andbracing. Spine ,1993 ,18 (9) :971-976.
[16]. Weinstein JN ,Collalto P ,Lehmann TR. Thoracolumbar“burst”frac2tures treated conservatively :A long2term follow2up. Spine , 1988 , 13(1) :33-38.
[17]. Oxland TE , Panjabi MM ,Southern EP ,et al. An anatomic basis for spinal instability : A porcine trauma model. J Orthop Res , 1991 , 9 :452-462.
[18]. Hashimoto T , Kandea K,Abumi K. Relationship between traumatic spinal canal stensis and neurologic deficits in thoracolumbar burst fracture. Spine ,1988 ,13 (12) :126821278.
[19]. Bedbrook GM. Treatment of thoracolumbar dislocation and fractures with paraplegia. Clin Orthop ,1975 ,112 :27-43.
[20] Roy-Camille R, Saillant G,Mazel C.Plating of thoracic thoracolumbar and lumbar injuries with pedicle screw plates. Orthop Clin North Am,1986,17(1):147-160.
[21].Tezeren G,kuru I.Posterior fixation of thoracolumbar burst fracture short-segment pedicle fixation versus long-segment instrumentation.Journal of Spinal Disorders &Techniques,2005,18(6):485-488..
[22]. VerlaanJJ,et al.Surgical treatment of traumatic fractures of the thoracic and lumbar spine-A systematic review of the literature on techniques,complications,and outcome. Spine,2004.,29(7):803-814.
[23]邱勇,朱泽章,王斌,吕锦瑜,俞杨,等.钉钩联合使用预防胸腰椎骨折术后纠正丢失的远期临床效果.中华创伤杂志,2003,12(5):742-745.
[24]. Muller U,Berlemann U, Sledge J, et al.Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stablization with monosegmental fution[J].Eur Spine,1999,8:284-289.
[25]. Bridwell KH, Dewald RL.Spinal.Surgery[M].2 nd ed.Philadelphia (NY):Kippincott Raven Publishers, 1997,1839-1880.