胸腰段Chance骨折发生机制、诊断及治疗的临床研究

发布时间：2018-07-15 15:10

【摘要】：目的：探讨各种病因在胸腰段Chance骨折中的具体机制及作用，对Chance骨折的主要病因进行趋势性预测。探讨X线、CT、MR等影像学检查方法各自特点及在胸腰段Chance骨折中的诊断价值。探讨在后外侧植骨下，后路椎弓根螺钉长节段固定与后路椎弓根螺钉短节段固定的治疗效果。探讨漏误诊病例，分析原因，寻找避免措施。方法：选取我院2012年1月至2014年1月于我院手术的28名胸腰段Chance骨折患者为研究对象。对其临床及影像学资料进行回顾性研究。1.病因机制：统计各类病因中的具体例数，计算百分比，分析受伤机制。2.诊断：查阅术前影像学资料，总结分析X线、CT、MR各自的影像学特征及病例数，计算百分比，分析影像学特征的形成原因及三种影像学诊断方法价值。3.手术治疗：28名患者均为后外侧植骨，将其按照固定节段的不同，分为A组：长节段固定组（8枚椎弓根钉）；B组：短节段固定组（4枚椎弓根钉）。随访时间，A组：14.47月±6.72，B组：13.64月±7.14。比较两组的一般资料：包括年龄、性别、随访时间。比较两组的术前资料：包括术前椎体前缘相对高度、术前Cobb角、术前伤椎楔变角。术前ASIA分级；术前Oswestry功能障碍指数(Oswestry disability Index,ODI)；术前视觉模拟评分（VisualAnalogue Score,VAS);比较两组的术中资料：包括手术所用时间、术中出血量；比较两组的术后资料：包括术后椎体前缘相对高度、术后椎体前缘高度矫正率、术后Cobb角、术后伤椎楔变角。比较两组的末次随访资料：包括末次随访椎体前缘相对高度、椎体前缘相对高度矫正丢失率、末次随访Cobb角、Cobb角矫正丢失度、末次随访伤椎楔变角、伤椎楔变角矫正丢失度。末次随访ASIA分级、末次随访ODI功能障碍指数、末次随访VAS评分。统计学方法采用SPSS22.0对相关指标进行检测分析，计量数据以x±s表示，满足正态分布的变量采用t检验，两组间比较采用均数独立样本t检验，不满足正态分布的变量采用卡方检验，置信区间均设置95％，p＜0.05代表两组数值间存在显著差异4.漏误诊：分析漏误诊原因：查体、影像（X线、CT、MR）各自的作用。结果：1.病因机制方面：高处坠落伤17例，占总病例数的60.71%；交通事故伤6例，占总病例数的21.42%；重物砸伤5例，占总病例数的17.86%。2.诊断方面：X线：正侧位片上见棘突间距离增宽者23例，占总病例数的82.14%。正位片上见一侧或双侧椎弓根低密度骨折线影者19例，占总病例数的67.85%。椎体中见横行低密度影垂直分离者16例，占总病例数的57.14%。侧位片上见横行低密度骨折线影伴垂直分离者20例，占总病例数的71.42%。CT：椎弓根溶解征20例，占总病例数的71.42%。关节面裸露征10例，占总病例数的35.71%。MPR重建矢状位上可观察到横行骨折线28例。行MRI检查者7例，4例可观察到典型的三明治征。3.手术治疗方面：一般资料及术前资料的对比，两组间比较无显著差异，P＞0.05。术中资料的对比：手术所用时间A组长于B组，术中出血量A组多于B组，组间比较有显著差异，P＜0.05。术后资料的对比：两组间比较无显著差异，，P＞0.05。两组末次随访资料的对比：末次随访时，两组的影像学资料的对比说明A组长期稳定性优于B组，组间比较有显著差异，P＜0.05。末次随访ASIA分级、ODI功能障碍指数、VAS评分，组间比较无显著差异，P＞0.05，说明临床治疗效果相近。4.漏误诊方面：28例患者中发现于急诊入院时1例漏诊病例。结论：1.高处坠落伤有取代交通事故伤成为Chance骨折的主要伤因的趋势。2.CT诊断方面优于X线，尤其矢状位重建方面具有直观准确的特性。MRI有助于后方软组织及神经损伤的评价。3.长节段固定稳定性优于短节段固定，短节段固定术中所用时间及术中出血量少于长节段固定，两者的临床治疗效果无明显差异。4.详细询问病史，仔细查体，合理而全面的影像学检查是避免漏诊、误诊的重要保证。
[Abstract]:Objective : To investigate the specific mechanism and function of various etiologies in fracture of thoracolumbar spinal cord Chance , and to predict the main cause of Chance fracture .

Methods : From January 2012 to January 2014 , 28 patients with fracture of thoracic and lumbar segment were studied retrospectively .
Group B : Short segment fixation group ( 4 pedicle screws ) . Follow - up time , group A : 14.47 months 卤 6.72 , group B : 13.64 months 卤 7.14 . Compare two groups of general data including age , sex , follow - up time . Compare two groups of pre - operative data : including relative height of anterior edge of anterior vertebral body , pre - operative cobb angle , pre - operative thoracic wedge angle . Preoperative ASIA classification ;
Oswestry disability index , preoperative Oswestry disability index ;
Preoperative visual analog score ( VAS ) ; comparison of intraoperative data between the two groups : time taken for surgery and intraoperative blood bleeding ;
The postoperative follow - up data were compared between the two groups : the relative height of the leading edge of the vertebral body , the correction rate of the leading edge of the vertebral body , the angle of correction of the vertebral wedge at the last follow - up , the angle of angle correction of the leading edge of the vertebral body , the angle of the last follow - up , the angle of angle correction of the vertebral body , the angle of the last follow - up , the correction of the angle of the vertebral wedge , the angle of angle correction of the last follow - up and the VAS score of the last follow - up .

Results : 1 . There were 17 cases of high altitude falling injury , accounting for 60 . 71 % of the total cases .
There were 6 cases of traffic accident , accounting for 21.42 % of the total cases .
The results showed that there were no significant difference between the two groups ( P > 0.05 ) . The results showed that there were no significant difference between the two groups .

Conclusion : 1 . There is a tendency of replacing traffic accident injury to be the main cause of fracture of Chance fracture . The CT diagnosis is superior to the X - ray and especially sagittal reconstruction . MRI is helpful to the evaluation of posterior soft tissue and nerve injury .
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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