Kuner E H, Kuner A, Schlickewei W, Mullaji A B
Department of Traumatology, University of Freiburg, Germany.
J Bone Joint Surg Br. 1994 Jan;76(1):107-12.
We assessed narrowing of the spinal canal in 39 burst fractures and fracture-dislocations of thoracolumbar vertebrae treated by the AO Internal Spinal Fixator, using CT preoperatively and at various stages postoperatively. Computer-aided planimetry was used to measure the narrowing, and its restoration shortly after instrumentation, or at 15 months. The mean initial reduction of canal area was to 63.7% +/- 18.8% of normal; this was restored to a mean of 95.4% +/- 21.2% of normal when measured either soon after surgery or at 15 months (p < 0.001 for both groups). There was more improvement in cases assessed later. For fractures from D12 to L3, the mean canal area was restored to 99.4% of normal; but at L4 or L5 the mean restitution was to only 60.9% (p < 0.05). We found no correlation between preoperative loss of area and amount of restoration, or severity of neurological deficit. Nor was there any correlation between the delay before surgery and the improvement achieved. The mechanism of fracture reduction appears to be a combination of distraction ligamentotaxis and forced hyperextension.
我们使用AO脊柱内固定器治疗了39例胸腰椎爆裂骨折和骨折脱位，通过术前及术后不同阶段的CT评估椎管狭窄情况。采用计算机辅助平面测量法测量狭窄程度及其在器械置入后不久或15个月时的恢复情况。椎管面积的平均初始减少至正常的63.7%±18.8%；术后不久或15个月测量时，平均恢复至正常的95.4%±21.2%（两组p均<0.001）。后期评估的病例改善更大。对于胸12至腰3骨折，椎管面积平均恢复至正常的99.4%；但在腰4或腰5，平均恢复仅为60.9%（p<0.05）。我们发现术前面积减少与恢复量或神经功能缺损严重程度之间无相关性。手术前的延迟与所取得的改善之间也无相关性。骨折复位的机制似乎是牵引韧带整复和强迫过伸的联合作用。
