伴前、中柱压缩的隐匿性胸腰椎屈曲牵张型骨折

Occult thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns

目的 分析伴前、中柱压缩的胸腰椎屈曲牵张型骨折表现隐匿的原因,并探讨其发生机制、影像学诊断及手术复位方法.方法 回顾性分析我院2003年5月-2006年12月收治的屈曲牵张型胸腰椎骨折患者39例,其中伴前、中柱压缩的患者17例,评价影像学检查（X线片、CT和MRI）的诊断价值,所有患者均给予后路手术,术中利用先单纯撑开复位前、中柱再行后方轴向加压复位后柱两步骤复位法进行复位内固定治疗,并评价该方法的临床效果及安全性.结果 伴前、中柱压缩的患者占全部屈曲牵张骨折患者的43.6%,17例术前有6例误诊为单纯压缩性骨折,各种影像学检查不同程度发现后柱骨性和（或）韧带复合体损伤的阳性结果：X线片8例,CT平扫7例,螺旋CT多平面重建（MPR）11例,MRI17例.17例单纯后路撑开后有8例出现后柱过撑现象,给予后方再加压进行复位后效果较好.结论 伴前、中柱压缩的屈曲牵张型骨折的后柱损伤表现常较隐匿,有一定临床发生率,但容易误诊为单纯压缩性骨折,CT MPR和MRI对诊断有较大帮助.采用先撑开再加压的两步骤复位法效果满意,且比较安全.

Objective To study a case series of thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns to analyze the causes of its occult symptoms and explore the injury mechanism,imaging diagnosis and operative reduction of the fractures.Methods A retrospective study was carried out on data of 39 patients with thoracolumbar flexion-distraction fractures admitted into our hospital from May 2003 to December 2006.Of all,there were 17 patients with compression of anterior and central columns.The diagnostic value of imaging examinations such as X-ray,CT and MRI was evaluated.All patients were treated with posterior operation,in which simple distraction of the anterior and central columns was followed by compression and reduction of the posterior column from the rear axial direction.The clinical efficacy and safety of operation were assessed.Results The patients with compression of anterior and central columns accounted for 43.6% of all thoracolumbar flexion-distraction fractures.Before operation,six patients were misdiagnosed as simple compression fracture.Various kinds of imaging examinations detected the bone injury and/or ligaments complex injury of the posterior column at different degrees.The positive results on X-ray,CT,spiral CT multi-planar reconstruction （MPR）and MRI were in 8,7,11 and 17 patients respectively.After simple posterior distraction in 17 patients,there occurred over distraction in eight patients who were cured with posterior recompression plus reduction.Conclusions The posterior column injury of thoracolumbar flexion-distraction fractures combined with compression of anterior and central columns is relatively occult and easy to be misdiagnosed as simple compression fracture,when MPR CT and MRI are helpful for diagnosis.The operation with twostep reduction of axial distraction followed by compression can attain satisfactory and safe results.