儿童及青少年胸腰椎脊柱创伤的研究进展

发布时间：2018-02-13 20:11

本文关键词： 儿童青少年脊柱创伤胸腰椎骨折研究进展　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：儿童及青少年胸腰椎脊柱创伤发病率低,但其误诊、误治导致的不良后果非常严重,值得引起创伤骨科医生的关注。由于其损伤机制、影像学特点和临床表现都与成人有所区别,故此治疗方案有很大不同。由于儿童及青少年脊柱尚处于生长发育过程中,其解剖结构有独特特点。与成人脊柱相比,其脊柱骨性结构有机质多无机质少,耐受形变能力更强,骨弹性模量更大,加之韧带及周围软组织比成人更具有柔韧性,故此儿童及青少年胸腰椎脊柱拥有更大的弹性及抗压缩性。特别是环状骨突骨折、椎体骺板损伤及无放射学影像异常的脊髓损伤(SCIWORA),为儿童及青少年特有的损伤类型,三者都具有其独特的损伤特点及诊治方案,是区别成人脊柱创伤的主要损伤类型。目前,对于儿童及青少年胸腰椎脊柱创伤临床治疗的认识还在不断发展,尚无统一的国际通用的诊疗标准。多数学者认为,绝大多数儿童及青少年胸腰椎脊柱创伤可以采取保守治疗,通过佩戴支具外固定、卧床休息等保守治疗方法,均可取得较为满意的疗效。在胸腰椎脊柱创伤合并脊柱结构不稳、严重脊柱后突畸形或严重脊髓神经系统损伤且进行性加重时,需行手术治疗。手术治疗原则和方法与成人相似,包括椎管减压、骨折复位、骨折内固定和椎间融合,由于儿童青少年处于生长发育高峰期,手术治疗以后路短阶段固定为主,尽可能减少脊柱融合节段。儿童及青少年脊柱脊髓损伤后,发生进行性脊柱畸形风险增高,故随访时间应到骨骺闭合骨骼成熟为止。
[Abstract]:The incidence of thoracolumbar spine trauma in children and adolescents is low, but its misdiagnosis and mistreatment are very serious, which deserves the attention of trauma orthopedic doctors. The imaging features and clinical manifestations are different from those of adults, so the treatment plan is very different. Because the spinal column of children and adolescents is still in the process of growth and development, its anatomical structure has unique characteristics. The spine has less organic matter, stronger resistance to deformation, greater elastic modulus of bone, and more flexibility of ligaments and surrounding soft tissues than adults. Therefore, the thoracolumbar spine of children and young people has greater elasticity and anti-compression. In particular, the fracture of annular bone process, the injury of epiphyseal lamina and the spinal cord injury without radiographic abnormality are specific types of injuries in children and adolescents. All of them have their unique injury characteristics and diagnosis and treatment plan, which are the main types of injuries to distinguish adult spinal trauma. At present, the clinical treatment of thoracolumbar spine trauma in children and adolescents is still developing. There is no unified international standard for diagnosis and treatment. Most scholars believe that the vast majority of children and adolescents with thoracolumbar spine trauma can be treated conservatively by wearing braces, external fixation, bed rest, etc. In the case of thoracolumbar spine trauma associated with spinal structure instability, severe spinal deformity or severe spinal cord nervous system injury and progressive aggravation, The principles and methods of surgical treatment are similar to those of adults, including spinal canal decompression, fracture reduction, fracture internal fixation and intervertebral fusion. The risk of progressive spinal deformity is increased after spinal cord injury in children and adolescents, so the follow-up time should be until the epiphyseal closed bone matures.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.8

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