【摘要】 目的 改良胸腰椎骨折手术的脊柱载荷分享评分，并应用该评分对临床效果进行分析。方法 以McCormack提出的脊柱载荷分享评分为基础，制定改良评分标准，即依据后凸畸形、椎体压缩程度、椎管内骨块占位为标准进行评分。抽取2002年6月至2007年1月应用改良法制定手术方案的200例具有完整资料的胸腰椎骨折病例进行回顾性分析，男120例，女80例；年龄17~78岁，平均47.3岁。采用改良评分法进行评价。评分结果显示，应采用后路手术105例，前路手术95例，但其中27例评分≥7分者因基础疾病、经济问题等原因而改行后路手术；故最终采用后路手术132例，前路手术68例。脊髓损伤采用Frankel分级，A级4例，B级11例，C级10例，D级19例，E级156例。结果 200例患者获得6~45个月的随访，平均20.3个月。对156例无神经损伤者进行功能评价：优112例，良32例，可8例，差4例，优良率92.3%。术后Frankel分级，A级4例，B级0例，C级4例，D级15例，E级177例。27例按改良评分应行前路手术而行后路手术患者中，4例术前椎管内占位严重且伴神经损伤者，末次随访时神经功能基本无恢复，椎管内占位骨块畸形愈合，残留严重椎管狭窄；发生椎弓根螺钉断钉3例，断棒1例，余23例椎弓根螺钉在椎体内均有不同程度的切割，表现为轻重不等的腰背酸痛。105例按改良评分≤ 6分者，行后路手术，随访时按功能评价：优84例，良21例。其中24例McCormack评分≥7分而改良评分≤6分者，行单纯后路手术，随访时均未出现断钉、断棒及椎体高度丢失现象。结论改良评分法更直观、便于测量、数据准确，实用性强，好记忆，便于掌握。

    【关键词】 脊柱；骨折；对比研究

    【证据等级】 诊断性研究Ⅳ级

 

    The improvement and clinical analysis of load-sharing classification of spine ZHANG Zhen-wu, RAO Xiao-hua, TIAN Ji-qing, et al. Tianshi Trauma Hospital, Jinyun 321405, China

    【Abstract】 Objective To explore the improvement of load-sharing classification for thoracolumbar spine fracture and analyze the clinical effects. Methods The standards load-sharing classification was modified based on kyphotic deformity, vertebral compression, and intraspinal mass. 200 patients with thoracolumbar spine fracture from June 2002 to Juuary 2007 were random selected from 650 patients and retrospectively analyzed with the improved load-sharing classification, including 120 males, 80 females, with the mean age of 47.3 years (ranged 17-78 years). According this improved classification, 105 patients should be performed posterior surgery, and 95 for anterior surgery, but 27 patients of them with more than 7 score were performed poterior surgery due to other combinding diseases and economic reasons. For the spin cord injury, there were 4 cases for Frankel A, 11 cases for Frankel B, 10 cases for Frankel C, 19 cases for Frankel D, and 156 cases for Frankel E preoperatively. Results All patients were followed up from 6 months to 45 months, with the mean period of 20.3 months. Among the 156 patients without nerve injuries, 112 cases were excellent according our nerve function evaluation, 32 for good, 8 for fair, 4 for poor, and the excellent and good rate was 92.3% postoperatively. For all patients, there were 4 cases for Frankel A, no cases for Frankel B, 4 cases for Frankel C, 15 cases for Frankel D, and 117 cases for Frankel E postoperatively. 105 patients with less than 6 score according the improved classification got satisfied effects after posterior operation. According to load-sharing classification system of McCormack's, 119 patients got more than 7 score, but according the improved classification, only 95 patients got more than 7 score. The 24 cases got satisfied effects after simply posterior surgery. Conclusion Our improved scoring methods of load-sharing classification have the advantages of convenience, practicability, and more consistent with the clinical practice.

    【Key words】 Spine； Fractures; Comparative study