Aydinli U, Karaeminoğullari O, Tişkaya K, Oztürk C
Department of Orthopaedics and Traumatology, School of Medicine, University of Abant Izzet Baysal, Düzce, Turkey.
Spine (Phila Pa 1976). 2001 Sep 15;26(18):E410-5. doi: 10.1097/00007632-200109150-00012.
This study investigated the incidence, predictions, and treatment principles of greenstick lamina fractures in lumbar burst fractures.
To determine the incidence of dural tears in lumbar burst fracture with greenstick lamina fracture and to find out if any specific clinical and radiographic factors or intraoperative pathologic findings are predictive of dural tears and nerve root entrapment.
A retrospective review was conducted on 45 patients with 47 lumbar burst fractures treated operatively. Ages ranged from 15 to 70 years (average, 33 years). The duration of follow-up ranged from 32 months to 8 years (average, 52 months).
All clinical charts and radiologic data of these patients were reviewed. Age, sex, etiology, and all the radiologic parameters were analyzed for their association with greenstick lamina fracture and dural tear. Student's t test and multiple logistic regression analysis were used for statistical analysis.
Greenstick lamina fracture occurred in 20 (42.5%) of 47 burst fractures. Dural tear was detected in 9 (19%) of 47 burst fractures and was predominantly higher in L3 (6 of 9 burst fractures). According to multiple logistic regression analysis of the data, a 20% increase in the interpedicular distance gives a 79% probability of greenstick lamina fracture. The distance between the edges of greenstick lamina fractures was obviously higher in fractures with dural tear. Neurologic status was completely normal before surgery in three of the patients with dural tear and nerve root entrapment.
It is not possible to detect dural tear and nerve root entrapment in greenstick lamina fracture before surgery. Therefore, if there is any suspicion of such an occurrence, it should be the rule to begin with posterior approach and use the open book technique to expose the dura safely before any reduction maneuver.
本研究调查了腰椎爆裂骨折中青枝状椎板骨折的发生率、预测因素及治疗原则。
确定合并青枝状椎板骨折的腰椎爆裂骨折中硬脊膜撕裂的发生率，并找出是否有任何特定的临床、影像学因素或术中病理发现可预测硬脊膜撕裂和神经根受压。
对45例接受手术治疗的47例腰椎爆裂骨折患者进行了回顾性研究。年龄范围为15至70岁（平均33岁）。随访时间为32个月至8年（平均52个月）。
回顾了这些患者的所有临床病历和放射学数据。分析年龄、性别、病因及所有放射学参数与青枝状椎板骨折和硬脊膜撕裂的相关性。采用学生t检验和多元逻辑回归分析进行统计学分析。
47例爆裂骨折中有20例（42.5%）发生青枝状椎板骨折。47例爆裂骨折中有9例（19%）检测到硬脊膜撕裂，主要发生在L3节段（9例爆裂骨折中有6例）。根据对数据的多元逻辑回归分析，椎弓根间距增加20%时，发生青枝状椎板骨折的概率为79%。硬脊膜撕裂的骨折中，青枝状椎板骨折边缘之间的距离明显更高。3例硬脊膜撕裂和神经根受压患者术前神经功能完全正常。
术前无法检测青枝状椎板骨折中的硬脊膜撕裂和神经根受压。因此，如果怀疑有此类情况发生，应常规先采用后路入路，并在进行任何复位操作之前使用“翻开书本”技术安全暴露硬脊膜。
