胸腰椎骨折后路复位术后椎体“空壳”现象的影像学研究

发布时间：2018-06-23 11:44

本文选题：胸腰椎骨折 + “空壳”现象　；参考：《中国修复重建外科杂志》2017年08期

【摘要】：目的分析胸腰椎骨折后路复位术后椎体"空壳"影像学特征,探讨椎体"空壳"与骨折愈合间的关系。方法回顾分析2013年1月—2015年12月,采用经后路椎弓根钉棒系统复位内固定术治疗的116例胸腰椎骨折患者临床资料。男72例,女44例;年龄22~66岁,平均43岁。致伤原因:交通事故伤24例,高处坠落伤54例,重物砸伤38例。骨折节段:T11 5例,T12 38例,L1 52例,L2 21例。压缩性骨折51例,爆裂性骨折65例。矢状面Cobb角8~27°,平均15°;伤椎前缘压缩程度20%~75%,平均44%。骨密度测量显示:骨量正常30例,骨量减少40例,骨质疏松41例,严重骨质疏松5例。观察术后椎体"空壳"现象发生例数、病理特点及影像学规律,并进行多因素logistic回归分析。结果术后患者均获随访,随访时间11~18个月,平均13个月。共72例出现椎体"空壳"现象,主要集中于椎体前柱及上终板薄弱区附近(54/72,75.0%),以不规则形为主(50/72,69.5%)。椎体骨折线走行与椎体"空壳"形态和复位后椎体骨折块移位有关;"空壳"形态转归可分为消失型、缩小型和塌陷型,椎体"空壳"体积和转归类型是影响椎体骨折愈合的危险因素。结论胸腰椎骨折后路复位术后椎体"空壳"发生率及骨折不愈合率均较高,椎体"空壳"转归类型及体积是其主要影响因素。
[Abstract]:Objective to analyze the imaging features of hollow shell of vertebral body after posterior reduction of thoracolumbar fracture, and to explore the relationship between hollow shell of vertebral body and fracture healing. Methods from January 2013 to December 2015, 116 patients with thoracolumbar fractures were treated with posterior pedicle screw and rod system reduction and internal fixation. There were 72 males and 44 females, aged 2266 years, with an average age of 43 years. The causes of injury were traffic accident in 24 cases, falling injury in 54 cases and heavy object injury in 38 cases. Fracture segment: T11 5 cases T 12 38 cases L 1 52 cases L 2 21 cases. Compression fracture 51 cases, burst fracture 65 cases. The Cobb angle of sagittal plane was 827 掳(mean 15 掳), and the compression degree of anterior edge of injured vertebrae was 20% (mean 44 掳). Bone mass was normal in 30 cases, osteopenia in 40 cases, osteoporosis in 41 cases and severe osteoporosis in 5 cases. The incidence, pathological features and imaging characteristics of the "empty shell" of the vertebral body after operation were observed, and multivariate logistic regression analysis was carried out. Results all patients were followed up for 11 ~ 18 months (mean 13 months). A total of 72 cases appeared "empty shell" of vertebral body, mainly located near the weak area of anterior column and superior endplate (54 / 72or 75.0%) and irregular shape (50 / 72) (69.5%). The pattern of fracture line of vertebral body is related to the shape of "hollow shell" of vertebral body and the displacement of fracture block of vertebral body after reduction, and the shape of "empty shell" can be divided into vanishing type, shrinking type and collapsing type. The volume and outcome type of vertebral shell are the risk factors of vertebral fracture healing. Conclusion the incidence of "hollow shell" and the rate of nonunion of vertebral body after posterior reduction of thoracolumbar fractures are higher, and the type and volume of "empty shell" of vertebral body are the main influencing factors.
【作者单位】：自贡市第四人民医院骨一科;
【基金】：四川省卫生与计划生育委员会项目(16PJ596) 自贡市科技局项目(2016SF04)~~
【分类号】：R687.3

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