Panjabi M M, Oxland T R, Kifune M, Arand M, Wen L, Chen A
Department of Orthopaedics & Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA.
Spine (Phila Pa 1976). 1995 May 15;20(10):1122-7. doi: 10.1097/00007632-199505150-00003.
This study validated the three-column theory of fractures by correlating the multidirectional instabilities and the vertebral injuries to each of the three columns, using a biomechanic trauma model.
The objective was to validate the three-column theory as applied to the thoracolumbar fractures.
The widely used three-column theory of fractures for classification and evaluation was based on retrospective analysis of radiographs. No biomechanic study, using realistic spinal fractures and multidirectional instability measurements, was available.
Using 16 fresh cadaveric thoracolumbar human spine specimens, two groups of burst fractures were produced by either simple axial compression or flexion-compression, using a high-speed trauma model. Multidirectional flexibility was measured before and after the trauma, thus quantifying the instability of the burst fracture. Computed tomography scans were taken after the fracture, and a newly developed injury scoring scheme quantified the injuries to the anterior, middle, and posterior columns. Statistical correlations were obtained between the flexibility parameters and injuries to each of the three columns.
In the axial compression group, the middle column injury, compared with the other two columns, showed the highest correlations to eight of the nine flexibility parameters (average R2 = 0.77). In the flexion-compression group, again the middle column injury showed the highest correlations to eight of the nine flexibility parameters (average R2 = 0.85).
The results of this study supported the three-column theory of the thoracolumbar fractures and bolstered the concept of the middle column being the primary determinant of mechanical stability of this region of the spine.
本研究通过使用生物力学创伤模型，将多方向不稳定性和椎体损伤与三柱中的每一列相关联，验证了骨折的三柱理论。
目的是验证应用于胸腰椎骨折的三柱理论。
广泛应用于分类和评估的骨折三柱理论是基于对X线片的回顾性分析。尚无使用真实脊柱骨折和多方向不稳定测量的生物力学研究。
使用16个新鲜的尸体胸腰椎人类脊柱标本，通过高速创伤模型，采用单纯轴向压缩或屈曲-压缩产生两组爆裂骨折。在创伤前后测量多方向灵活性，从而量化爆裂骨折的不稳定性。骨折后进行计算机断层扫描，一种新开发的损伤评分方案量化了前柱、中柱和后柱的损伤。获得了灵活性参数与三柱中每一列损伤之间的统计相关性。
在轴向压缩组中，与其他两柱相比，中柱损伤与九个灵活性参数中的八个显示出最高的相关性（平均R2 = 0.77）。在屈曲-压缩组中，中柱损伤再次与九个灵活性参数中的八个显示出最高的相关性（平均R2 = 0.85）。
本研究结果支持胸腰椎骨折的三柱理论，并支持中柱是脊柱该区域机械稳定性主要决定因素的概念。
