Wessberg P, Wang Y, Irstam L, Nordwall A
Department of Orthopedics, Institute of Surgical Sciences, University of Gothenburg, Sweden.
Eur Spine J. 2001 Feb;10(1):55-63. doi: 10.1007/s005860000194.
Bone fragments in the spinal canal after thoracolumbar spine injuries causing spinal canal narrowing is a frequent phenomenon. Efforts to remove such fragments are often considered. The purpose of the present study was to evaluate the effects of surgery on spinal canal dimensions, as well as the subsequent effect of natural remodelling, previously described by other authors. A base material of 157 patients operated consecutively for unstable thoracolumbar spine fractures at Sahlgrenska University Hospital in Gothenburg during the years 1980-1988 were evaluated, with a minimum of 5-years follow-up. Of these, 115 had suffered burst fractures. Usually the Harrington distraction rod system was employed. Patients underwent computed tomography (CT) preoperatively, postoperatively and at follow-up. From digitized CT scans, cross-sectional area (CSA) and mid-sagittal diameter (MSD) of the spinal canal at the level of injury were determined. The results showed that the preoperative CSA of the spinal canal was reduced to 1.4 cm2 or 49% of normal, after injury. Postoperatively it was widened to 2.0 cm2 or 72% of normal. At the time of follow-up, the CSA had improved further, to 2.6 cm2 or 87%. The extent of widening by surgery depended on the extent of initial narrowing, but not on fragment removal. Remodelling was dependent on the amount of bone left after surgery. The study shows that canal enlargement during surgery is caused by indirect effects when the spine is distracted and put into lordosis. Remodelling will occur if there is residual narrowing. Acute intervention into the spinal canal, as well as subsequent surgery because of residual bone, should be avoided.
胸腰椎损伤后椎管内出现骨碎片导致椎管狭窄是一种常见现象。人们常常考虑努力清除这些碎片。本研究的目的是评估手术对椎管尺寸的影响，以及先前其他作者所描述的自然重塑的后续效果。对1980年至1988年期间在哥德堡的萨尔格伦斯卡大学医院连续接受不稳定胸腰椎骨折手术的157例患者作为基础材料进行评估，随访时间至少5年。其中，115例为爆裂骨折。通常采用哈灵顿撑开棒系统。患者在术前、术后及随访时均接受计算机断层扫描（CT）检查。通过数字化CT扫描，确定损伤水平处椎管的横截面积（CSA）和矢状径（MSD）。结果显示，损伤后椎管的术前CSA降至1.4平方厘米或正常的49%。术后增宽至2.0平方厘米或正常的72%。随访时，CSA进一步改善至2.6平方厘米或87%。手术增宽的程度取决于初始狭窄的程度，但不取决于碎片清除情况。重塑取决于手术后剩余的骨量。研究表明，手术期间椎管扩大是脊柱撑开并形成前凸时的间接效应所致。如果存在残余狭窄，将会发生重塑。应避免对椎管进行急性干预以及因残留骨而进行的后续手术。
