胸腰椎爆裂骨折后伤椎矢状面压缩面积和骨碎块面积的测量及其意义

Extent of sagittal-sectional fractured area in thoracolumbar burst fractures

目的测量胸腰椎爆裂骨折后伤椎矢状面压缩面积、骨碎块面积和骨折总累及面积,并探讨其临床意义。方法对45例胸腰椎爆裂骨折进行X线和CT矢状面重建检查。在侧位X线图像上测量伤椎矢状面压缩面积,矢状面重建CT图像上测量伤体压缩面积、骨碎块面积和骨折总累及面积。结果 X线图像测量的伤椎压缩面积百分比为(29.32±13.80)%。CT图像测量的伤椎压缩面积百分比为(27.93±12.21)%,两者差异无统计学意义(P>0.05)。CT图像测量的伤椎骨折总累及面积百分比为(53.20±20.64)%,明显大于X线和CT图像测量的伤椎压缩面积百分比(P<0.01)。CT图像测量的伤椎骨碎块面积百分比为(25.27±15.18)%,与伤椎压缩面积无明显相关性(r=0.1258,P>0.05)。结论胸腰椎爆裂骨折后潜在不稳定性与伤椎的骨碎块面积有关,伤椎有机械力学性能缺陷的部分为骨折总累及面积。胸腰椎爆裂骨折后X线图像显示的伤体压缩面积不能反映骨碎块面积,且低估了骨折总累及面积。CT矢状重建能弥补X线检查的不足,对胸腰椎骨折治疗措施的选择具有参考意义。

Objective To investigate the amount of vertebral body （VB） compression,fracture bony fragraents and fracture involvement in thoracolmnbar burst fractures. Methods Lateral radiographs and spiral computed tomography scans with muhiplanar reconstruction of forty-five patients with thoracolumbar burst fractures were performed, to determine the amount of fractured VB compression, fracture fragments and fracture involvement. Results There was （29.32±13.80）% compression of the VB on X-ray images and （27.93±12.21）% on CT reconstruction images; no significant difference was found in the two groups（P 〉0.05）. （53.20±20.64）% comminution of the body on sagittal-planar reconstruction CT scan was found, which was significantly greater than the amount of VB compression （P 〈0.01） and （25.2±15.18）% of the vertebral body was bony fragments, which was not significantly correlated with the amount of VB compression （P 〉0.05）. Conclusion Plain radiograph dose not evaluate the extent of vertebral body comminution. Sagittal CT reconstruction image could well describe the amount of bony comminution in a spinal fracture, which may lead to better fracture treatment.