Department of Spine Surgery, Zhejiang Spine Research Center, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Spine (Phila Pa 1976). 2018 Jun 1;43(11):774-779. doi: 10.1097/BRS.0000000000002425.
Retrospective cohort study.
To reveal the risk factors for dural tears in thoracic and lumbar (TL) burst fractures associated with vertical laminar fractures through multivariate analysis.
Dural tears associated with laminar fractures in patients with TL burst fractures represents a special group requires distinct treatment with different surgical prognosis. It is still very difficult to predict dural tears in patients with vertical laminar fractures. The risk factors for dural tears have seldom been evaluated.
Medical records of 113 patients of TL burst fractures with vertical laminar fractures were reviewed. The data were subdivided into two groups consisting of patients with and without dural tears. Demographic information, preoperative clinical, and radiological characteristics were compared between the groups. Multivariate logistic regression models were employed to determine the independent risk factors for dural tears.
The incidence of dural tear was 27.4% in this retrospective cohort. When compared with the dural intact group, the dural tear group had significantly worse preoperative neurological status, wider interpedicular distance, greater separation of laminar fractures, and larger encroachment of retropulsed fragment in the bony spinal canal. Multivariate stepwise logistic regression analysis showed that the ratio of interpedicular distance greater than 125% (odds ratio = 9.5; P < 0.001) and the ratio of encroachment of retropulsed fragment in the bony spinal canal of more than 50% (odds ratio = 61.2; P < 0.001) were independent risk factors for dural tears.
Patients with wider interpedicular distance and larger encroachment of retropulsed fragment in the bony spinal canal were more likely to have dural tears in TL burst fractures with vertical laminar fractures.
回顾性队列研究。
通过多变量分析揭示与垂直椎板骨折相关的胸腰椎（TL）爆裂骨折硬膜撕裂的危险因素。
TL 爆裂骨折伴椎板骨折的硬膜撕裂患者属于特殊群体，需要采用不同的手术方法进行治疗，且预后不同。目前，预测伴有垂直椎板骨折的患者发生硬膜撕裂仍然非常困难，对于硬膜撕裂的危险因素也很少有研究进行评估。
回顾性分析了 113 例 TL 爆裂骨折伴垂直椎板骨折患者的病历资料。将数据分为两组，一组为伴有硬膜撕裂的患者，另一组为无硬膜撕裂的患者。比较两组患者的人口统计学信息、术前临床和影像学特征。采用多变量逻辑回归模型确定硬膜撕裂的独立危险因素。
本回顾性队列中，硬膜撕裂的发生率为 27.4%。与硬膜完整组相比，硬膜撕裂组患者术前神经功能状态较差，椎弓根间距较宽，椎板骨折分离程度较大，骨椎管内骨块后凸侵入程度较大。多变量逐步逻辑回归分析显示，椎弓根间距大于 125%的比例（比值比=9.5；P<0.001）和骨椎管内骨块后凸侵入程度大于 50%的比例（比值比=61.2；P<0.001）是硬膜撕裂的独立危险因素。
TL 爆裂骨折伴垂直椎板骨折患者，椎弓根间距较宽、骨椎管内骨块后凸侵入程度较大者更易发生硬膜撕裂。
3 级。
