Ruiz Santiago Fernando, Tomás Muñoz Pablo, Moya Sánchez Elena, Revelles Paniza Marta, Martínez Martínez Alberto, Pérez Abela Antonio Luis
Radiology Department, Hospital of Traumatology, Carretera de Jaen SN, Granada 18014, Spain.
Radiology Department, Ciudad Sanitaria Virgen de las Nieves (Hospital Complex University of Granada), Avenida de las Fuerzas Armadas 2, Granada 18014, Spain.
Quant Imaging Med Surg. 2016 Dec;6(6):772-784. doi: 10.21037/qims.2016.12.04.
This article describes different types of vertebral fractures that affect the thoracolumbar spine and the most relevant contributions of the different classification systems to vertebral fracture management. The vertebral fractures types are based on the three columns model of Denis that includes compression, burst, flexion-distraction and fracture-dislocation types. The most recent classifications systems of these types of fractures are reviewed, including the Thoracolumbar Injury Classification and Severity score (TLICS) and the Arbeitsgemeinschaft für Osteosynthesefragen Spine Thoracolumbar Injury Classification and Severity score (AOSpine-TLICS). Correct classification requires a quantitative imaging approach in which several measurements determine TLICS or AOSpine-TLICS grade. If the TLICS score is greater than 4, or the AOSpine-TLICS is greater than 5, surgical management is indicated. In this review, the most important imaging findings and measurements on radiography, multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) are described. These include degree of vertebral wedging and percentage of vertebral height loss in compression fractures, degree of interpedicular distance widening and spinal canal stenosis in burst fractures, and the degree of vertebral translation or interspinous widening in more severe fractures types, such as flexion-distraction and fracture-dislocation. These findings and measurements are illustrated with schemes and cases of our archives in a didactic way.
本文描述了影响胸腰椎的不同类型的椎体骨折，以及不同分类系统对椎体骨折治疗的最相关贡献。椎体骨折类型基于Denis的三柱模型，包括压缩型、爆裂型、屈曲-牵张型和骨折脱位型。本文回顾了这些类型骨折的最新分类系统，包括胸腰椎损伤分类和严重程度评分（TLICS）以及骨科学会脊柱胸腰椎损伤分类和严重程度评分（AOSpine-TLICS）。正确的分类需要一种定量成像方法，其中多项测量可确定TLICS或AOSpine-TLICS分级。如果TLICS评分大于4，或AOSpine-TLICS大于5，则表明需要手术治疗。在本综述中，描述了X线摄影、多排螺旋计算机断层扫描（MDCT）和磁共振成像（MRI）上最重要的影像学表现和测量方法。这些包括压缩性骨折的椎体楔形变程度和椎体高度丢失百分比、爆裂性骨折的椎弓根间距增宽程度和椎管狭窄程度，以及更严重骨折类型（如屈曲-牵张型和骨折脱位型）的椎体移位程度或棘突间增宽程度。这些发现和测量方法通过我们存档的示意图和病例以教学的方式进行了说明。
