螺旋CT在胸腰椎爆裂骨折患者Denis分型与椎体前缘受压分度诊断中的价值及骨折不愈合影响因素分析

The Value of Spiral CT in the Diagnosis of Denis Classification and Vertebral Anterior Compression Grading in Patients with Thoracolumbar Burst Fracture and the Analysis of Influencing Factors of Fracture Nonunion

目的探究螺旋CT在胸腰椎爆裂骨折患者Denis分型、椎体前缘受压分度诊断中的价值,并分析骨折不愈合的影响因素.方法回顾性分析2012年10月—2021年4月南京医科大学附属常州第二人民医院收治的44例胸腰椎爆裂骨折患者的临床资料,分别在手术前后行X线扫描和螺旋CT扫描,比较两种方式诊断Denis分型、椎体前缘受压分度的效果.比较手术前后椎体内骨缺损空隙的最大高度(GH)、椎体前缘高度、后凸Cobb角、骨密度(BMD)值.随访1年后,统计骨折不愈发生率,将患者分为愈合组和不愈组,并比较骨折不愈患者手术前后的椎体内骨缺损空隙GH、椎体前缘高度、后凸Cobb角、BMD值及一般临床资料,探讨骨折不愈的独立影响因素.结果螺旋CT的Denis分型及椎体前缘受压分度诊断准确率均高于X线,差异有统计学意义(P<0.05).术后,患者的GH、后凸Cobb角均较术前减小,椎体前缘高度较术前增加,BMD值较术前增大,差异具有统计学意义(P<0.05).44例患者出院后,均接受长达1年的随访,无失访患者.有12例患者出现骨折不愈情况,骨折不愈发生率为27.27%.愈合组与不愈组的性别、术前GH、术前椎体前缘高度、术前后凸Cobb角、术前BMD值比较,组间差异无统计学意义(P>0.05);愈合组的年龄、术后GH、术后后凸Cobb角小于不愈组,术后椎体前缘高度、术后BMD值大于不愈组,组间差异有统计学意义(P<0.05).术后GH、术后椎体前缘高度、术后后凸Cobb角、术后BMD值均是骨折不愈合的独立危险因素(P<0.05).结论采用螺旋CT诊断胸椎腰椎爆裂骨折的Denis分型、椎体前缘受压分度具有较高准确率.术后椎体内空隙高度、术后椎体前缘高度、术后后凸Cobb角、术后BMD值均是骨折不愈合的独立危险因素,采用螺旋CT评估术后恢复效果具有一定价值.

Objective To explore the value of spiral CT in the diagnosis of Denis classification and vertebral anterior edge pressure grading in patients with thoracolumbar burst fractures,and to analyze the influencing factors of fracture nonunion.Methods The clinical data of 44 patients with thoracolumbar burst fractures admitted to Changzhou Second People's Hospital Affiliated to Nanjing Medical University from October 2012 to April 2021 were retrospectively analyzed.Xray scan and spiral CT scan were performed before and after operation,and the effects of the two methods in the diagnosis of Denis classification and vertebral anterior edge pressure classification were compared.The gap-height(GH)of the bone defect void in the vertebral body,the height of the anterior edge of the vertebral body,the Cobb angle of the kyphosis,and the bone mineral density(BMD)were compared before and after surgery.After 1 year of follow-up,the incidence of fracture unhealing was statistically analyzed,and the patients were divided into a healing group and an unhealing group.The GH of the bone defect void in the vertebral body,vertebral anterior edge height,kyphosis Cobb angle,BMD value and general clinical data of patients with fracture unhealing before and after surgery were compared,and the independent influencing factors of fracture unhealing were discussed.Results The diagnosis accuracy of Denis classification and vertebral anterior edge pressure classification by spiral CT were higher than those by X-ray,and the differences were statistically significant(P<0.05).After surgery,the patient's GH and posterior convex Cobb angle decreased,the height of the anterior vertebral body increased,and the BMD value increased compared with that before surgery,with statistically significant differences(P<0.05).All 44 patients were followed up for up to 1 year after discharge,and no patients were lost to follow-up.There were 12 patients with fracture unhealing,the incidence of fracture unhealing was 27.27%.There were no significant differences in gender,preoperative GH,preoperative anterior vertebral height,preoperative kyphosis Cobb angle,and preoperative BMD between the healing group and the unhealing group(P>0.05);while the age,postoperative GH,postoperative kyphosis Cobb angle of the healing group were lower than those of the non-healing group,and the height of the anterior vertebral body and postoperative BMD were higher than those of the unhealing group,and the differences between the groups were statistically significant(P<0.05).Postoperative GH,postoperative anterior vertebral height,postoperative kyphosis Cobb angle,and postoperative BMD were independent risk factors for fracture nonunion(P<0.05).Conclusion Spiral CT has high accuracy in the diagnosis of Denis classification and vertebral anterior edge pressure classification of thoracic and lumbar burst fractures.Postoperative vertebral space height,postoperative vertebral anterior height,postoperative kyphosis Cobb Angle,and postoperative BMD value are independent risk factors for fracture nonunion.Spiral CT has certain value in evaluating the postoperative recovery effect.