Shuman W P, Rogers J V, Sickler M E, Hanson J A, Crutcher J P, King H A, Mack L A
AJR Am J Roentgenol. 1985 Aug;145(2):337-41. doi: 10.2214/ajr.145.2.337.
Cross-sectional spinal canal area was measured before and after surgery in 12 patients with thoracolumbar burst fractures and canal narrowing caused by retropulsed fragments. Patients were classified into Denis type A or type B. Denis type A fractures have comminution of both end-plates of the vertebral body creating multiple smaller fractures; Denis type B fractures have comminution of the superior end-plate only with a single vertical fracture line into the inferior end-plate creating larger fragments. The degree of neurologic impairment was assessed before and after surgery using the Frankel system. There was no correlation between degree of canal narrowing and degree of neurologic impairment. The degree of spinal canal narrowing reflects the final resting position of the vertebral body fragments after trauma; during trauma, greater degrees of canal impingement may have occurred. Also, significant canal narrowing may be present without pinching of the cord or cauda equina. All patients with Denis type A fractures had near-anatomic reduction of fragments out of the spinal canal by surgery; less than half of the patients with Denis type B had good reduction. There was no correlation between reduction of retropulsed fragments and subsequent neurologic improvement. However, this should not preclude surgery as a therapeutic option: Eight of 10 patients with neurologic impairment experienced some improvement in symptoms after surgery; the other two were unchanged.
对12例胸腰椎爆裂骨折且伴有骨折块后突导致椎管狭窄的患者，在手术前后测量其横断面椎管面积。患者被分为Denis A型或B型。Denis A型骨折椎体的终板均粉碎，形成多个较小的骨折块；Denis B型骨折仅上终板粉碎，有一条垂直骨折线延伸至下终板，形成较大的骨折块。术前和术后采用Frankel系统评估神经功能损害程度。椎管狭窄程度与神经功能损害程度之间无相关性。椎管狭窄程度反映了创伤后椎体骨折块的最终静止位置；在创伤过程中，可能发生了更严重的椎管受压。此外，即使没有脊髓或马尾神经受压，也可能存在明显的椎管狭窄。所有Denis A型骨折患者经手术治疗后骨折块几乎达到解剖复位，自椎管内移出；不到一半的Denis B型骨折患者获得了良好的复位。骨折块后突复位与随后的神经功能改善之间无相关性。然而，这并不应排除手术作为一种治疗选择：10例神经功能损害患者中有8例术后症状有所改善，另外2例无变化。
