中国修复重建外科杂志

中国修复重建外科杂志

胸腰椎骨折后路复位术后椎体“空壳”现象的影像学研究

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目的 分析胸腰椎骨折后路复位术后椎体“空壳”影像学特征,探讨椎体“空壳”与骨折愈合间的关系。 方法 回顾分析 2013 年 1 月—2015 年 12 月,采用经后路椎弓根钉棒系统复位内固定术治疗的 116 例胸腰椎骨折患者临床资料。男 72 例,女 44 例;年龄 22~66 岁,平均 43 岁。致伤原因:交通事故伤 24 例,高处坠落伤 54 例,重物砸伤 38 例。骨折节段:T11 5 例,T12 38 例,L1 52 例,L2 21 例。压缩性骨折 51 例,爆裂性骨折 65 例。矢状面 Cobb 角 8~27°,平均 15°;伤椎前缘压缩程度 20%~75%,平均 44%。骨密度测量显示:骨量正常 30 例,骨量减少 40 例,骨质疏松 41 例,严重骨质疏松 5 例。观察术后椎体“空壳”现象发生例数、病理特点及影像学规律,并进行多因素 logistic 回归分析。 结果 术后患者均获随访,随访时间 11~18 个月,平均 13 个月。共 72 例出现椎体“空壳”现象,主要集中于椎体前柱及上终板薄弱区附近(54/72,75.0%),以不规则形为主(50/72,69.5%)。椎体骨折线走行与椎体“空壳”形态和复位后椎体骨折块移位有关;“空壳”形态转归可分为消失型、缩小型和塌陷型,椎体“空壳”体积和转归类型是影响椎体骨折愈合的危险因素。 结论 胸腰椎骨折后路复位术后椎体“空壳”发生率及骨折不愈合率均较高,椎体“空壳”转归类型及体积是其主要影响因素。

Objective To analyze the imaging characteristics of vertebral " shell” phenomenon of thoracolumbar fractures after posterior reduction and to explore the relationship between vertebral " shell” and fracture healing. Methods Between January 2013 and December 2015, the clinical data of 116 patients with thoracolumbar fractures treated with posterior pedicle screw-rod system reduction and internal fixation were analyzed retrospectively. There were 72 males and 44 females, aged 22-66 years (mean, 43 years). Injury causes were traffic accident in 24 cases, falling from height in 54 cases, bruise in 38 cases. Fracture segment located at T11 in 5 cases, T12 in 38 cases, L1 in 52 cases, L2 in 21 cases. There were 51 cases of compressive fracture and 65 cases of burst fracture. The sagittal Cobb angle ranged from 8 to 27°, with an average of 15°. Degree of preoperative spinal compression ranged from 20% to 75%, with an average of 44%. Bone density measurement showed that normal bone mass in 30 cases, bone loss in 40 cases, osteoporosis in 41 cases, and severe osteoporosis in 5 cases. The number, pathological characteristics, and imaging regularity of the vertebral " shell” phenomenon were observed and analyzed by logistic regression. Results All patients were followed up 11-18 months with an average of 13 months. A total of 72 cases of vertebral " shell” phenomenon mainly located in the vertebral anterior column and the end plate near the weak area (54/72, 75.0%). Most of them were in the irregular shape (50/72, 69.5%). The vertebral fracture line was related to the shape of the vertebral body and the displacement of the vertebral body after reduction. The outcome of the " shell” can be divided into disappeared type, reduced type, and collapse type, the volume of vertebral " shell” and its outcome were the risk factors for vertebral fracture healing. Conclusion The incidence of vertebral " shell” and nonuion of thoracolumbar fractures after posterior reduction are high. The main influencing factors are vertebral " shell” outcome and size.

关键词: 胸腰椎骨折; “空壳”现象; 内固定; 影像学特征

Key words: Thoracolumbar fracture; " shell” phenomenon; internal fixation; imaging characteristic

引用本文: 胡海刚, 林旭, 谭伦, 吴超, 钟泽莅, 曾俊, 邓佳燕. 胸腰椎骨折后路复位术后椎体“空壳”现象的影像学研究. 中国修复重建外科杂志, 2017, 31(8): 976-981. doi: 10.7507/1002-1892.201611009 复制

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