Mohanty S P, Bhat N S, Abraham R, Ishwara Keerthi C
Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India.
J Orthop Surg (Hong Kong). 2008 Apr;16(1):20-3. doi: 10.1177/230949900801600105.
To assess whether canal compromise determines neurological deficit in thoracolumbar and lumbar burst fractures.
105 patients aged 17 to 60 (mean, 34) years who had burst fractures in the thoracolumbar (n=82) and lumbar (n=23) regions were included. Fractures were classified according to the Denis classification. The extent of spinal canal compromise was assessed by computed tomography, and the neurological status according to the modified Frankel grading for traumatic paraplegia.
19 (18%) of the patients had no neurological deficit. Of the remaining 86 (82%) with a deficit, 26 had complete paraplegia. The correlation between the type of the burst fracture and the severity of neurological deficit was not significant (Chi squared=10.57, p=0.835). The mean extent of spinal canal compromise in patients with deficits was 50%, whereas in patients with no deficit it was 36%. The difference between the extent of canal compromise and the severity of neurological deficit at the thoracolumbar and lumbar spine was not significant (p=0.08). Further subanalysis revealed a significant correlation at T11 and T12 (p=0.007) but not at the L1 (p=0.42) level.
When studying neurological deficit, T11 and T12 injuries should be analysed separately from L1 injuries.
评估椎管受累情况是否决定胸腰段和腰椎爆裂骨折的神经功能缺损。
纳入105例年龄在17至60岁（平均34岁）之间、胸腰段（n = 82）和腰椎（n = 23）发生爆裂骨折的患者。骨折根据Denis分类法进行分类。通过计算机断层扫描评估椎管受累程度，并根据改良Frankel外伤性截瘫分级评估神经功能状态。
19例（18%）患者无神经功能缺损。其余86例（82%）有神经功能缺损的患者中，26例为完全性截瘫。爆裂骨折类型与神经功能缺损严重程度之间的相关性不显著（卡方检验=10.57，p = 0.835）。有神经功能缺损患者的椎管平均受累程度为50%，而无神经功能缺损患者为36%。胸腰段和腰椎椎管受累程度与神经功能缺损严重程度之间的差异不显著（p = 0.08）。进一步的亚组分析显示，在T11和T12水平存在显著相关性（p = 0.007），但在L1水平不存在（p = 0.42）。
在研究神经功能缺损时，T11和T12损伤应与L1损伤分开分析。
