椎弓根钉棒系统置入复位内固定胸腰段椎体爆裂骨折的椎管形态变化

Change of spinal canal morphology after pedicle screw rod system fixation and reduction for thoracolumbar burst fracture

背景:目前胸腰椎爆裂骨折在椎弓根器械复位固定后观察指标为椎体基本形态的影像学检查,对于复位后椎管形态变化的研究鲜有报道。目的:分析胸腰段椎体骨折予以椎弓根钉棒系统内固定复位治疗后椎管形态变化的规律。方法:对28例胸腰段椎体爆裂骨折予以椎弓根钉棒系统内固定复位的患者进行治疗后随访,所有患者分别于治疗前、治疗后1周,治疗后1年及治疗后2年拍胸腰椎正侧位X射线片,所有患者术前均行伤椎上下椎体的CT断层扫描,其中26例获得了治疗前、治疗后1周,及治疗后1年左右的CT横断扫描影像资料,2例部分影像学资料丢失。先于胸腰椎侧位X射线片上辨别椎体后缘有无骨折块突入椎管,同时观察椎体形态变化;CT横断扫描影像资料上测量椎管正中矢状径表示椎管占位程度。结果与结论:28例侧位X射线片上可看出椎体后缘骨块突入椎管者治疗前有18例(64.2%),治疗后6例(21.4%),治疗后1年时2例(7.1%),至治疗后2年1例(3.5%);治疗前正中矢状径平均为42.6%(n=28)。有完整随访影像学资料的26例中治疗后CT片正中矢状径平均为75.2%(P<0.05),治疗后1年平均正中矢状径为91.2%(n=26)。提示胸腰段椎体爆裂骨折行椎弓根钉棒系统内固定及复位治疗后椎管占位复位作用明显,治疗后远期观察椎管形态基本可恢复正常。

BACKGROUND： At present, the observation index of the thoracolumbar burst fracture after pedicle instrument reset is the imaging examination of vertebral body basic form, and the reports on the changes of morphology of spinal canal after reduction are rare. OBJECTIVE： To analyze the changes of morphology of spinal canal after thoracolumbar fractures treated with pedicle screw rod system fixation and reduction. METHODS： Twenty-eight cases of thoracolumbar burst fracture treated with pedicle screw rod system fixation and reduction were followed-up after operation, and all patients took the thoracolumbar anteroposterior and lateral X-ray film before treatment, 1 week, 1 and 2 years after operation. All the patients underwent CT scans of the upper and lower vertebral body, of which 26 patients obtained the image data of CT scan before treatment, 1 week, 1 and 2 years after operation, and partial image information of two patients lost. Whether the fracture block of the posterior margin of vertebral body went into the spinal canal or not was identified on the thoracic and lumbar spine lateral X-ray film firstly, and the changes of spinal canal morphology were observed; the spinal median sagittal diameter measured based on the CT scanning image data represented the spinal space-occupying degree. RESULTS AND CONCLUSION： Lateral X-ray films of the 28 cases showed the fracture block of the posterior margin of vertebral body of 18 cases （64.2%） went into the spinal canal before operation, fracture block of six cases （21.4%） went into the spinal canal after operation, two cases （7.1%） at 1 year after operation, one cases （3.5%） at 2 years after operation; the average spinal median sagittal diameter was 42.6% （n=28） before operation. The spinal median sagittal diameter of the 26 cases with complete follow-up imaging data was 75.2% （P 〈 0.05）, and the median sagittal diameter at 1 year after operation was 91.2% （n=26）. The occupying reduction effect of spinal canal is obvious after thoracolumbar burst fracture treated with pedicle screw rod system fixation and reduction, the postoperative long-term observation shows the spinal canal morphology can be restored to normal.