Jun Deuk Soo, Shin Won Ju, An Byoung Keun, Paik Je Won, Park Min Ho
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University, Incheon, Korea.
MiRaeRo EuRatCha Orthopaedic Clinic, Seoul, Korea.
Asian Spine J. 2015 Apr;9(2):170-7. doi: 10.4184/asj.2015.9.2.170. Epub 2015 Apr 15.
Retrospective study.
To investigate the relation between the progression of kyphotic deformity and magnetic resonance imaging (MRI) findings in conservatively treated stable thoracolumbar fractures.
When treated conservatively, excessive progression of kyphotic deformity and vertebral compression can emerge during follow-up. We sought to identify predictors of vertebral body deformation using MR images.
The presence in MR images of anterior longitudinal ligament (AL) or posterior longitudinal ligament (PL) injury, superior or inferior endplate disruption, superior or inferior disc injury in fractured vertebral bodies, the existence of low signal intensity on T2 weighted images, and bone edema of intravertebral bodies were assessed.
The presence of superior endplate disruption and a higher level of bone edema were found to cause the progressions of kyphotic angle (KA), wedge angle (WA), and anterior vertebral compression (AVC) rate. When AL or superior disc injury was observed, only KA increased meaningfully. When low signal intensity was present on T2 weighted images WA and AVC increased significantly, but PL injury, inferior endplate disruption, and inferior disc injury showed no notable correlation with kyphotic deformity progression. The risk factors found to be associated with an increase of KA to >5° were AL injury, superior endplate disruption, superior disc injury, and a bone edema level of over 1/3, and their associated risks versus no injury cases were 14.1, 3.7, 6.8, and 10.4-fold, respectively.
AL injury, superior endplate and disc injury, or a high level of bone edema, were critical factors that determine kyphotic deformity progression.
回顾性研究。
探讨保守治疗的稳定型胸腰椎骨折后凸畸形进展与磁共振成像（MRI）表现之间的关系。
保守治疗时，随访期间可能出现后凸畸形和椎体压缩过度进展的情况。我们试图利用磁共振图像确定椎体变形的预测因素。
评估骨折椎体的前纵韧带（AL）或后纵韧带（PL）损伤、上或下终板破坏、上或下椎间盘损伤在磁共振图像中的存在情况，T2加权图像上低信号强度的存在情况以及椎体内骨水肿情况。
发现上终板破坏的存在和较高程度的骨水肿会导致后凸角（KA）、楔角（WA）和椎体前缘压缩（AVC）率的进展。观察到AL或上椎间盘损伤时，只有KA有显著增加。当T2加权图像上存在低信号强度时，WA和AVC显著增加，但PL损伤、下终板破坏和下椎间盘损伤与后凸畸形进展无明显相关性。发现与KA增加>5°相关的危险因素为AL损伤、上终板破坏、上椎间盘损伤和骨水肿程度超过1/3，与无损伤病例相比，它们的相关风险分别为14.1、3.7、6.8和10.4倍。
AL损伤、上终板和椎间盘损伤或高水平的骨水肿是决定后凸畸形进展的关键因素。
