胸腰椎爆裂骨折椎间盘影像改变的相关临床应用研究

Imaging Alteration of Intervertebral Discs after Thoracolumbar SpineBurst Fracture in Clinic Analysis

目的通过评价胸腰椎爆裂骨折后椎间盘影像的改变,探讨不同类型胸腰椎爆裂骨折与椎间盘损伤程度的相关性以及处理受损椎间盘的重要意义。方法收集24例胸腰椎爆裂骨折的影像学资料,根据Atlas对胸腰椎爆裂骨折的分类方法评估患者的骨折类型。结合其受伤椎体邻近椎间盘的Oner椎间盘损伤分级,收集数据后对其进行相关统计分析。结果在Atlas分类A型骨折中,所有受累下位椎间盘损伤级别为2型而其相应的上位椎间盘损伤级别为3、4、和5型。在Atlas分类B型骨折中,所有受累下位椎间盘损伤级别皆为1型而其相应的上位椎间盘损伤级别都高于下位椎间盘。结论胸腰椎爆裂骨折患者椎间盘终板的损伤与椎间盘的损伤密切相关,受损椎体上位椎间盘较下位椎间盘更易损伤且损伤程度更重。对于胸腰椎爆裂骨折患者前路手术较后路手术具有更好的稳定性。

Objective To compare the imaging of the intervertebral discs in different type of end- plate fractures and to try to help surgeon to choose proper clinical therapy in thoraeolumbar spine burst fracture which is one of the major spinal fractures in clinic. Methods The imaging data of 24 cases of thoracolumbar spine burst fracture including X - ray, CT and MRI were colleted. The imaging data of 48 intervertebral disc adjacent to the involved vertebra from 24 patients with surgery were obtained. The atlas classification was used to define different type of thoracolumbar spine burst fracture. Every disc was evaluated by different injuries extents. Experimental data were analyzed with Photoshop 8.0, image-pro ptus and SPSS 13.0. Results The injuries were found in most of the intervertebral discs and the signals changes on MRI in the superior disc were more obvious. In type A endplate fractures, 6 of 7 superior disc injuries extents were scored in type 3, 4 or 5 while 7 of 7 inferior disc were scored in type 2. In type B endplate fractures, all of the inferior disc was scored in type 1 while 12 of 13 superior disc injuries extents were scored in type 2 or 3. Conclusion In thoracolumbar spine burst fracture, fractures of the endplate are related with type of fractures. In type A and B fracture the superior disk are more vulnerable and have more severe injury extents in burst fracture.