發(fā)布時(shí)間：2018-02-13 20:11

  本文關(guān)鍵詞： 兒童 青少年 脊柱創(chuàng)傷 胸腰椎骨折 研究進(jìn)展　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：兒童及青少年胸腰椎脊柱創(chuàng)傷發(fā)病率低,但其誤診、誤治導(dǎo)致的不良后果非常嚴(yán)重,值得引起創(chuàng)傷骨科醫(yī)生的關(guān)注。由于其損傷機(jī)制、影像學(xué)特點(diǎn)和臨床表現(xiàn)都與成人有所區(qū)別,故此治療方案有很大不同。由于兒童及青少年脊柱尚處于生長(zhǎng)發(fā)育過程中,其解剖結(jié)構(gòu)有獨(dú)特特點(diǎn)。與成人脊柱相比,其脊柱骨性結(jié)構(gòu)有機(jī)質(zhì)多無機(jī)質(zhì)少,耐受形變能力更強(qiáng),骨彈性模量更大,加之韌帶及周圍軟組織比成人更具有柔韌性,故此兒童及青少年胸腰椎脊柱擁有更大的彈性及抗壓縮性。特別是環(huán)狀骨突骨折、椎體骺板損傷及無放射學(xué)影像異常的脊髓損傷(SCIWORA),為兒童及青少年特有的損傷類型,三者都具有其獨(dú)特的損傷特點(diǎn)及診治方案,是區(qū)別成人脊柱創(chuàng)傷的主要損傷類型。目前,對(duì)于兒童及青少年胸腰椎脊柱創(chuàng)傷臨床治療的認(rèn)識(shí)還在不斷發(fā)展,尚無統(tǒng)一的國(guó)際通用的診療標(biāo)準(zhǔn)。多數(shù)學(xué)者認(rèn)為,絕大多數(shù)兒童及青少年胸腰椎脊柱創(chuàng)傷可以采取保守治療,通過佩戴支具外固定、臥床休息等保守治療方法,均可取得較為滿意的療效。在胸腰椎脊柱創(chuàng)傷合并脊柱結(jié)構(gòu)不穩(wěn)、嚴(yán)重脊柱后突畸形或嚴(yán)重脊髓神經(jīng)系統(tǒng)損傷且進(jìn)行性加重時(shí),需行手術(shù)治療。手術(shù)治療原則和方法與成人相似,包括椎管減壓、骨折復(fù)位、骨折內(nèi)固定和椎間融合,由于兒童青少年處于生長(zhǎng)發(fā)育高峰期,手術(shù)治療以后路短階段固定為主,盡可能減少脊柱融合節(jié)段。兒童及青少年脊柱脊髓損傷后,發(fā)生進(jìn)行性脊柱畸形風(fēng)險(xiǎn)增高,故隨訪時(shí)間應(yīng)到骨骺閉合骨骼成熟為止。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.8

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