胸腰椎爆裂性骨折后椎管狭窄与神经功能的损伤:二者有无相关性

Spinal stenosis and neurologic impairment after blow-out thoracolumbar fractures: With or without correlation between them

目的:探讨不同部位胸腰椎爆裂性骨折CT断层扫描测得的椎管狭窄程度与神经功能损伤的关系。方法:选择2003-02/2004-10天津骨科医院脊柱外科收治的外伤性胸腰椎爆裂骨折患者68例,均为T11,T12,L1,L24个节段中任一椎体的爆裂骨折。患者入院后进行①脊髓功能评估:采用Frankel分级法,分5级,A(5分)为完全损伤,B(4分)为仅有感觉,C(3分)为运动存在但无功用,D(2分)为有功用的运动,E(1分)为正常。②CT断层扫描的测量:测量骨折脊椎相邻上下位各一脊椎的椎管面积,取其均数作为受伤椎体正常椎管面积,选定自上而下出现椎弓根影的扫描层,椎管面积测量用透明的面积测算纸计数小方格(2mm×2mm)累积计算,取椎管面积缩小百分率记录。以测量的受伤椎管的有效面积与正常椎管面积的比率来反映椎管的狭窄度。将受伤椎体CT断层扫描椎管占位面积的百分比和脊髓功能的Frankle评分进行直线相关分析。结果:68例患者的Frankle评分和受伤椎体的CT断层扫描测量结果均纳入分析。①胸腰椎爆裂性骨折患者脊髓功能Frankle评分结果:T11,T12,L1,L2分别为1.95±1.24,3.14±1.46,1.82±1.19,1.90±1.20。②胸腰椎爆裂性骨折患者受伤椎体CT断层扫描椎管占位面积的百分比:T11,T12,L1,L2分别为(42.78±21.13)%,(48.24±24.96)%,(30.88±26.42)%,(44.00±26.71)%。③胸腰椎爆裂骨折患者脊髓功能Frankle评分和受伤椎体CT断层扫描椎管占位面积百分比的相关分析:脊髓神经功能损伤程度与椎管内骨块占位存在显著相关,相关程度以T12最高(r=0.87),L2最低(r=0.59)。结论:①椎管内骨性占位形成椎管狭窄与神经损伤程度总体上存在相关性,在T12水平相关程度最高,在L2水平相关程度最低。②相同程度椎管狭窄致脊髓神经损伤危险性T11和T12水平较L1和L2水平大,说明椎管受压越严重,骨折部位越高,发生神经损伤的可能性越大。

AIM： To study the relationship between the level of spinal canal stenosis and neural functional injury measured by CT fault images in different part of blow-out thoracolumbar fractures. METHODS： Sixty-eight patients with trauma blow-out thoracolumbar fractures treated in Department of Spine Surgery of Tianjin Orthopaedics Department Hospital between February 2003 and October 2004 were selected. They were all blow-out fractures in any part of 4 centrum segment, T11 ,T12, L2, L2. After hospitalization the patients were performed ① The evaluation of spinal cord function： Using Frankel grade method, including 5 grades, A （5 points） completely injured, B （4 points） only with sensation, C （3 points） movement existing but without usage, D （2 points） movement with usage, E （1 point） normal. ② The measurement of CT fault image： The area of vertebral canal of every upper and lower vertebra around fracture vertebra was measured, and the average area was gained as the normal area of vertebral canal of injured vertebral body. The scan layer of podicle of vertebral arch shadow presented from upper to lower was collected. The area of vertebral canal measure was accumulated to calculate by hyaline area measure paper counting litter check （2 mm×2 mm） to got and the shorten percentage record of vertebral canal area. The constriction degree of vertebral canal was reflected by the ratio of utility area and normal vertebral canal area of measured injured vertebral canal. The percentage of occupying area of vertebral canal of injured vertebral body with CT fault image and the Frankle score of spinal cord function were performed the linear correlation analysis. RESULTS： The Frankle score and the measure result of CT fault image on injured vertebral body in 68 patients were all involved the analysis. ①The Frankle score result of spinal cord function in patients with blow-out thoracolumbar fractures： T11, T12, L1, L2 was 95±1.24, 3.14±1.46, 1.82±1.19, 1.90±1.20 respectively. ②The percentage of occupying area of vertebral canal of injured vertebral body＇ with CT fault image in patients with blow-out thoracolumbar fractures： T11, T12, L2, L2 was （42.78±21.13）%, （48.24±24.96）%, （30.88±26.42）%, （44.00±26.71）% respectively. ③ The correlation analysis between Frankle score of spinal cord function and the percentage of occupying area of vertebral canal of injured vertebral body with CT fault image in patients with blow-out thoracolumbar fractures： There were significant correlation between the injured degree of spinal nerves function and the bones occupying in vertebral canal, and the correlative degree with the highest of T12 （r=0,87） and the lowest of L2=0,59）. CONCLUSION： ① The spinal stenosis formed by bones occupancy in vertebral canal and injury of nerve degree exist correlation in generally, the T12 level has the highest correlative degree and L2 level has the lowest correlative degree. ② The risk of the same degree vertebral canal constriction induced spinal nerves injury in T11 and T12 level was bigger than that in L2 and L2 level, which indicates that the more serious the pressure of vertebral canal, the higher the fracture part, and the occurrence of injury of nerve has bigger possibility.