Skiak E, Karakasli A, Harb A, Satoglu I S, Basci O, Havitcioglu H
Karatas Hospital, Department of Orthopedics and Traumatology, 35260 Konak, Izmir, Turkey.
Dokuz Eylul University, Department of Orthopedics and Traumatology, 35340 Inciraltı, Izmir, Turkey.
Orthop Traumatol Surg Res. 2015 Jun;101(4):489-94. doi: 10.1016/j.otsr.2015.02.011. Epub 2015 Apr 28.
The treatment of fractures involving the lumbar spine has been controversial. Laminae lesion may be complete or of the greenstick type (incomplete). Dural tears and nerve root entrapment may accompany these laminae fractures. The aim of this study is twofold, to assess the effect of different types of laminae fractures on the anteriorvertebral height restoration in upper lumbar burst fractures and to determine the incidences of the intraoperatively detected dural tear and neural entrapment in complete and incomplete laminae fractures to choose the optimal treatment.
A retrospective review was conducted on 112 patients with 114 lumbar burst fractures treated operatively, age ranged from 17 to 55 years (mean age 32). Male to female ratio was (93%/7%), 8 females. Patients were divided into three groups, group 1 patients without lamina fracture, group 2 patients with complete type lamina fracture and group 3 patients with (percutaneous) incomplete type lamina fractures. All clinical charts and radiologic data of these groups were analyzed for their association with dural tears, neural entrapment and the impact of lamina fracture (complete and incomplete types) on the efficacy of anterior vertebral height restoration. The severity of injury was determined using the ASIA (Modified Frankel scale).
Out of 114 upper lumbar burst fractures, lamina fracture occurred in 34 patients (29.8%), complete lamina fracture occurred in 21 patients (61.7%), whereas incomplete lamina fracture occurred in 13 patients (38.3%). Dural tear was detected in 16 patients (47%) and was predominantly higher in complete type lamina fracture 12 patients (57%) when compared to 4 dural tears (30%) in incomplete lamina fractures. Analysis of the data revealed no significant difference in the preoperative anterior vertebral height loss and local kyphotic angle between the three groups. However the anterior vertebral height and local kyhpotic angle restoration were found to be affected by the presence of complete lamina fracture when compared to other groups with incomplete lamina fracture and without lamina fracture (P=0.001).
In upper lumbar burst fractures, complete lamina fracture is an indicator of injury severity. When detected preoperatively on CT or MRI scanning, it should be operated by open book laminectomy even if the patient is neurologically intact since it carries a high risk of neural entrapment, and its presence affects the intraoperative postural and instrumental trials for anterior vertebral height restoration.
腰椎骨折的治疗一直存在争议。椎板损伤可能是完全性的或青枝骨折型（不完全性）。这些椎板骨折可能伴有硬脊膜撕裂和神经根受压。本研究的目的有两个，一是评估不同类型的椎板骨折对上腰椎爆裂骨折椎体前缘高度恢复的影响，二是确定完全性和不完全性椎板骨折术中检测到的硬脊膜撕裂和神经受压的发生率，以选择最佳治疗方法。
对112例接受手术治疗的114例腰椎爆裂骨折患者进行回顾性研究，年龄在17至55岁之间（平均年龄32岁）。男女比例为（93%/7%），女性8例。患者分为三组，第1组为无椎板骨折的患者，第2组为完全性椎板骨折的患者，第3组为（经皮）不完全性椎板骨折的患者。分析这些组的所有临床图表和放射学数据，以了解它们与硬脊膜撕裂、神经受压的关系，以及椎板骨折（完全性和不完全性类型）对椎体前缘高度恢复疗效的影响。使用ASIA（改良Frankel量表）确定损伤的严重程度。
在114例上腰椎爆裂骨折中，34例（29.8%）发生椎板骨折，其中21例（61.7%）为完全性椎板骨折，13例（38.3%）为不完全性椎板骨折。16例（47%）检测到硬脊膜撕裂，与不完全性椎板骨折中的4例硬脊膜撕裂（30%）相比，完全性椎板骨折中的硬脊膜撕裂主要更高，为12例（57%）。数据分析显示，三组术前椎体前缘高度丢失和局部后凸角无显著差异。然而，与其他不完全性椎板骨折组和无椎板骨折组相比，发现完全性椎板骨折的存在会影响椎体前缘高度和局部后凸角的恢复（P = 0.001）。
在上腰椎爆裂骨折中，完全性椎板骨折是损伤严重程度的一个指标。当术前在CT或MRI扫描中检测到时，即使患者神经功能完好，也应采用翻开式椎板切除术进行手术，因为其神经受压风险高，且其存在会影响术中恢复椎体前缘高度的体位和器械操作试验。
