[胸腰椎骨折后路复位后“蛋壳”现象的影像学研究]
[Imaging study of "shell" phenomenon of thoracolumbar fractures after posterior reduction].
作者信息
Hu Haigang, Lin Xu, Tan Lun, Wu Chao, Zhong Zeli, Zeng Jun, Deng Jiayan
机构信息
No.1 Department of Orthopedics, Zigong Fourth People's Hospital, Zigong Sichuan, 643000, P.R.China.
No.1 Department of Orthopedics, Zigong Fourth People's Hospital, Zigong Sichuan, 643000,
出版信息
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Aug 15;31(8):976-981. doi: 10.7507/1002-1892.201611009.
OBJECTIVE
To analyze the imaging characteristics of vertebral "shell" phenomenon of thoracolumbar fractures after posterior reduction and to explore the relationship between vertebral "shell" and fracture healing.
METHODS
Between January 2013 and December 2015, the clinical data of 116 patients with thoracolumbar fractures treated with posterior pedicle screw-rod system reduction and internal fixation were analyzed retrospectively. There were 72 males and 44 females, aged 22-66 years (mean, 43 years). Injury causes were traffic accident in 24 cases, falling from height in 54 cases, bruise in 38 cases. Fracture segment located at T in 5 cases, T in 38 cases, L in 52 cases, L in 21 cases. There were 51 cases of compressive fracture and 65 cases of burst fracture. The sagittal Cobb angle ranged from 8 to 27°, with an average of 15°. Degree of preoperative spinal compression ranged from 20% to 75%, with an average of 44%. Bone density measurement showed that normal bone mass in 30 cases, bone loss in 40 cases, osteoporosis in 41 cases, and severe osteoporosis in 5 cases. The number, pathological characteristics, and imaging regularity of the vertebral "shell" phenomenon were observed and analyzed by logistic regression.
RESULTS
All patients were followed up 11-18 months with an average of 13 months. A total of 72 cases of vertebral "shell" phenomenon mainly located in the vertebral anterior column and the end plate near the weak area (54/72, 75.0%). Most of them were in the irregular shape (50/72, 69.5%). The vertebral fracture line was related to the shape of the vertebral body and the displacement of the vertebral body after reduction. The outcome of the "shell" can be divided into disappeared type, reduced type, and collapse type, the volume of vertebral "shell" and its outcome were the risk factors for vertebral fracture healing.
CONCLUSION
The incidence of vertebral "shell" and nonuion of thoracolumbar fractures after posterior reduction are high. The main influencing factors are vertebral "shell" outcome and size.
目的
分析胸腰椎骨折后路复位后椎体“蛋壳”现象的影像学特征，探讨椎体“蛋壳”与骨折愈合的关系。
方法
回顾性分析2013年1月至2015年12月采用后路椎弓根螺钉-棒系统复位内固定治疗的116例胸腰椎骨折患者的临床资料。其中男性72例，女性44例，年龄22 - 66岁（平均43岁）。受伤原因：交通事故24例，高处坠落54例，重物砸伤38例。骨折节段：T12 5例，T11 38例，L1 52例，L2 21例。压缩骨折51例，爆裂骨折65例。矢状面Cobb角8° - 27°，平均15°。术前椎体压缩程度20% - 75%，平均44%。骨密度测量显示：骨量正常30例，骨量减少40例，骨质疏松41例，重度骨质疏松5例。采用logistic回归观察分析椎体“蛋壳”现象的数量、病理特征及影像学规律。
结果
所有患者随访11 - 18个月，平均13个月。共72例出现椎体“蛋壳”现象，主要位于椎体前柱及薄弱区附近终板（54/72，75.0%）。大部分呈不规则形（50/72，69.5%）。椎体骨折线与椎体形态及复位后椎体位移有关。“蛋壳”转归可分为消失型、缩小型和塌陷型，椎体“蛋壳”体积及其转归是椎体骨折愈合的危险因素。
结论
胸腰椎骨折后路复位后椎体“蛋壳”现象及不愈合发生率较高。主要影响因素为椎体“蛋壳”转归及大小。
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