Shi Xuchao, Xiang Shate, Dai Bo, He Zhennian
Department of Orthopedics Surgery of Beilun People's Hospital, No. 1288, Lushan East Road, Ningbo, 315800, Zhejiang Province, China.
College of Medical Technology, Zhejiang Chinese Medical University, No. 548, Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China.
BMC Musculoskelet Disord. 2021 Mar 23;22(1):300. doi: 10.1186/s12891-021-04178-9.
The appropriate and optimal treatment for thoracic and lumbar (TL) burst fractures remains a topic of debate. Characterization of vertical laminar fractures (coronal cross-sectional imaging) is presented in this study to determine the severity and treatment options in TL burst fractures.
A retrospective evaluation of 341 consecutive patients with TL burst fractures was divided into Group I (whole), Group II (partial), and Group III (intact) based on the vertical laminar fracture morphology from coronal images on computed tomography (CT) scans. The presence of preoperative neurological status was reviewed, and several radiological parameters were measured. In addition, the incidence of dural tears was calculated in patients that underwent a decompression with posterior approach.
In total, 270 lumbar and 71 thoracic burst fractures were analyzed. Compared with the intact group, the two other groups had significantly shorter central canal distance, wider interpedicular distance, and smaller spinal canal area, in particular, Group III. The incidences of preoperative neurological deficits in Groups I to III were 63.0, 22.2, and 6.3%, respectively. The incidences of dural tears in Groups I to III were 25.6, 6.3, and 0%, respectively.
The morphology of vertical laminar fractures observed across the coronal plane was important. Patients with "whole", "partial" and "intact" laminar fractures indicated different severity of TL burst fractures. Due to the high probability of dural tears, decompression is recommended as a primary intervention for patients with "whole" laminar fractures. However, for patients without vertical laminar fractures, minimally invasive technique might be a better choice to avoid approach-related complications.
胸腰椎爆裂骨折的恰当及最佳治疗方法仍是一个存在争议的话题。本研究展示了垂直椎板骨折（冠状面横断面成像）的特征，以确定胸腰椎爆裂骨折的严重程度及治疗方案。
对341例连续性胸腰椎爆裂骨折患者进行回顾性评估，根据计算机断层扫描（CT）冠状面图像上的垂直椎板骨折形态分为I组（完整）、II组（部分）和III组（完整）。回顾术前神经功能状态，测量多个影像学参数。此外，计算接受后路减压患者的硬脊膜撕裂发生率。
共分析270例腰椎和71例胸椎爆裂骨折。与完整组相比，其他两组的中央椎管距离明显缩短、椎弓根间距增宽、椎管面积减小，尤其是III组。I至III组术前神经功能缺损的发生率分别为63.0%、22.2%和6.3%。I至III组硬脊膜撕裂的发生率分别为25.6%、6.3%和0%。
冠状面观察到的垂直椎板骨折形态很重要。“完整”“部分”和“完整”椎板骨折的患者表明胸腰椎爆裂骨折的严重程度不同。由于硬脊膜撕裂的可能性高，对于“完整”椎板骨折的患者，建议将减压作为主要干预措施。然而，对于没有垂直椎板骨折的患者，微创技术可能是避免手术相关并发症的更好选择。
