[Objective] To discuss the opportunity and method of the posterior route operation in the upper-middle thoracic fracture to resume the thoracic vertebral normal sequence、decompression completely and reconstruction immediate stability as soon as possible,so as to relieve pressure to spinal cord and nerve and avoid the secondary trauma of spinal cord and nerve and blood vessel and patients can do rehabilitation.[Method]Seventeen cases of the patients with upper-middle thoracic vertebral fracture were operated on with posterior route early decompression、fusion、internal fixation under general anaesthesia.There were 17 cases including male 11 and female 6 with the ages from 18 to 53 years(average 33.8 years).The injury reason: 7 cases as traffic accident,10 cases as falling from high altitude.The time from trauma to hospital were 1 hr.to 72 hrs.(average 15.4 hrs.).The injured segment of vertebral: T5～T10 segment,T5 2 cases,T6 6 cases,T7 5 cases,T9 4 cases,T10 2 cases.The function evaluation of spinal cord: 10 cases with incompletely neurological defect,7 cases with completely neurological defect.[Result]All patients were followed for 6~27 months(average 13.5months).The thoracic vertebra restoration were contentment and bone fuse were obtained in 12 weeks after operation.10 cases with incompletely neurological defect got improved postoperatively and 5 cases activity normolly.7 cases with completely neurological defect got improved of numbness and pain.[Conclusion]The upper-middle thoracic vertebral fracture can be operated early and the outcome are contentment.

Objective To explore the implementation effects and application value of the Clinical Rehabilitation Integration Plan based on the graded management of rehabilitation treatment programs in a 3A general hospital.Methods The details of the programme were firstly formulated according to the needs of clinical rehabilitation and the implementation plan was formed,and then the integrated clinical rehabilitation work was carried out for 1 year accordingly,and finally the effects before and after the implementation of the programme were compared and analysed by selecting the indicators of departmental operation and patient satisfaction.Results The rehabilitation programme was classified into 4 levels according to the degree of technical difficulty and medical risk,and its connotation and management requirements were defined in detail.The implementation of the programme included organisational structure,training and assessment,authorisation management and quality control.The programme was carried out in 8 clinical departments in the hospital,and the overall willingness of the clinical departments to develop early rehabilitation was improved since 2022.Conclusion This program can improve the operational efficiency of clinical departments and patient prognosis.