Cammisa F P, Eismont F J, Green B A
University of Miami/Jackson Memorial Hospital Center, Florida.
J Bone Joint Surg Am. 1989 Aug;71(7):1044-52.
The cases of sixty patients in whom a burst fracture of a thoracic or lumbar vertebral body had been treated with posterior instrumentation and arthrodesis less than two weeks after the injury were retrospectively reviewed. Thirty of the patients had an associated laminar fracture. Eleven of the thirty, all of whom had a lumbar fracture and a preoperative neurological deficit, were noted at operation to have dural laceration. In four of the patients who had dural laceration, neural elements were entrapped between the fragments from the laminar fracture. None of the remaining thirty patients who did not have a laminar fracture had dural laceration (p = 0.0002). Univariate and multivariate statistical analysis revealed no significant association of the dural laceration with the patients' age or sex, or with the radiographic characteristics of the spine. There was a significant association between dural laceration and neurological deficit (p = 0.0001). In our series, the presence of a preoperative neurological deficit in a patient who had a burst fracture and an associated laminar fracture was a sensitive (100 per cent) and specific (74 per cent) predictor of dural laceration. The presence of this fracture pattern and an associated neurological deficit also predicted a risk of dural laceration with entrapped neural elements. This information may influence decisions as to whether an anterior or a posterior surgical approach should be used in such patients.
对60例胸腰椎椎体爆裂骨折患者进行回顾性研究，这些患者在受伤后不到两周接受了后路内固定和椎间融合术治疗。其中30例患者伴有椎板骨折。这30例患者中有11例（均为腰椎骨折且术前存在神经功能缺损）在手术中发现有硬脊膜撕裂。在4例硬脊膜撕裂的患者中，神经组织被夹在椎板骨折的碎片之间。其余30例没有椎板骨折的患者均未发生硬脊膜撕裂（p = 0.0002）。单因素和多因素统计分析显示，硬脊膜撕裂与患者的年龄、性别或脊柱的影像学特征无显著相关性。硬脊膜撕裂与神经功能缺损之间存在显著相关性（p = 0.0001）。在我们的系列研究中，对于椎体爆裂骨折并伴有椎板骨折的患者，术前存在神经功能缺损是硬脊膜撕裂的敏感（100%）且特异（74%）的预测指标。这种骨折类型及相关神经功能缺损的存在也预示着存在神经组织被夹的硬脊膜撕裂风险。这些信息可能会影响对此类患者采用前路还是后路手术方法的决策。
