Denis F, Burkus J K
Minnesota Spine Center, Minneapolis.
Spine (Phila Pa 1976). 1991 Aug;16(8 Suppl):S433-9.
Posterior dural lacerations associated with lumbar burst fractures are caused by impaction of the dural sac into the vertical lamina fracture. Neural elements may be extruded outside of the dura and become entrapped in the lamina fracture. This diagnosis must be made before surgery and is based on the patient's clinical presentation, the fracture pattern, and the radiographic findings. Entrapped neural elements can be successfully extracted from the lamina fracture by an opening laminoplasty of the posterior neural arch. Patients with lumbar burst fractures and radiographic evidence of posterior displacement of the neural elements in the lamina fracture should undergo posterior exploration of the spinal canal, extraction of cauda equina neural elements, and repair of the dural laceration before any spinal reduction maneuver.
与腰椎爆裂骨折相关的硬脊膜后裂伤是由于硬脊膜囊嵌入垂直的椎板骨折所致。神经组织可能会被挤出硬脊膜外并被困在椎板骨折处。该诊断必须在手术前做出，依据患者的临床表现、骨折类型及影像学检查结果。通过后路神经弓切开成形术可成功地从椎板骨折处取出被困的神经组织。对于腰椎爆裂骨折且有影像学证据显示椎板骨折处神经组织向后移位的患者，在进行任何脊柱复位操作之前，均应行椎管后路探查、马尾神经组织取出及硬脊膜裂伤修复术。
