Oner F C, van der Rijt R R, Ramos L M, Dhert W J, Verbout A J
University Hospital, Utrecht, The Netherlands.
J Bone Joint Surg Br. 1998 Sep;80(5):833-9. doi: 10.1302/0301-620x.80b5.8830.
We have studied the intervertebral discs adjacent to fractured vertebral bodies using MRI in 63 patients at a minimum of 18 months after injury. There were 75 thoracolumbar fractures of which 26 were treated conservatively and 37 by posterior reduction and fusion with an AO internal fixator. We identified six different types of disc using criteria based on the morphology and the intensity of the MRI signal. The inter- and intraobserver variability of this system was good. Most of the discs showed predominantly morphological changes with no variation in signal intensity. Some disc types were associated with progressive kyphosis in patients treated conservatively. In those managed by operation, recurrent kyphosis appeared to result from creeping of the disc in the central depression of the bony endplate rather than from disc degeneration. Changes in the disc space after posterior fixation should not be seen as a form of chronic instability but as a redistribution of the disc tissue in the changed morphology of the space after fractures of the endplate.
我们对63例患者受伤至少18个月后的相邻于骨折椎体的椎间盘进行了MRI研究。共有75例胸腰椎骨折，其中26例采用保守治疗，37例采用后路复位并使用AO内固定器融合治疗。我们根据MRI信号的形态和强度标准确定了六种不同类型的椎间盘。该系统的观察者间和观察者内变异性良好。大多数椎间盘主要表现为形态学改变，信号强度无变化。一些椎间盘类型与保守治疗患者的进行性后凸相关。在手术治疗的患者中，复发性后凸似乎是由于椎间盘在骨终板中央凹陷处的蠕动，而非椎间盘退变所致。后路固定后椎间盘间隙的变化不应被视为一种慢性不稳定形式，而应被视为终板骨折后椎间盘组织在形态改变的间隙中的重新分布。
