胸腰椎骨折椎管狭窄与神经功能的关系

Relationship between Spinal Canal Stenosis and Neurological Deficit in Thoracolumbar Fractures

对106例连续性胸腰椎爆裂骨折进行回顾性研究,探讨椎管狭窄与神经功能的关系。按自行设计的改良Frankel法将神经功能分六级,将椎管分脊髓圆锥段和马尾神经段,用直线回归相关法分析椎管狭窄与神经损伤程度之间的关系,用等级相关法分析椎管狭窄与发生神经损伤可能性之间的关系。结果表明:无论在脊髓圆锥段或马尾神经段,椎管狭窄与神经损伤程度、损伤可能性之间均存在相关性(r或r_s=0.38～0.90,P<0.05),且脊髓圆锥段的相关程度较高;相同程度椎骨狭窄致神经危害性在脊髓圆锥段较大。发生神经损伤的最小椎管狭窄在脊髓圆锥段为38％,在马尾神经段为63％(?)认为胸腰椎骨折椎管狭窄是神经损伤的主要因素,X-CT扫描可较好地预测神经损伤程度和损伤可能性。

One hundred and six consecutive cases of thoracohrmar burst fractures were studied retrospectively to investi-gate the relationship between spinal canal stenosis and neurological deficit. Neurological deficit was divided into six grades according to authors' modified Frankel classification, spinal canal was devided into spinal cord - conus medullaris and cauda equina segments. We used linear correlation and linear regression to analyse the relationship between spinal canal stenosis and severity of neurological deficit, rank correlation for the relationship of spinal canal stenosis to probability of neurological deficit. The results showed that spinal canal stenosis correlated with severity and probability of neurological deficit not only in spinal cord-conus medullaris segment but also in cauda equina segment (r or r5 = 0.38 ~0.90, P < 0.05). The degree of correlation was higher and the same degree of spinal canal stenosis made more harm to neurological deficit in spinal cord - conus medullaris segment. The least spinal canal stenosis of neurological deficit in spinal cord -conus medullaris and cauda equina segments were 38% and 63% respectively. Conclusion: the most reasons for neuro-logical deficit are spinal canal stenosis in thoracolumbar fractures and X-CT scan may predict severity and probability of neurological deficit.