胸腰椎骨折后方韧带复合体损伤顺序及其意义

Sequential damage of posterior ligamentous complex and its clinical significance in patients with thoracolumbar fracture

目的 借助MRI影像,研究胸腰椎骨折时后方韧带复合体（PLC）损伤的先后顺序及其意义. 方法 收集2008年9月-2012年9月132例脊柱骨折患者的X线片、CT和MRI抑脂序列检查资料.按骨折形态行AO骨折分型,棘间韧带（ISL）、棘上韧带（SSL）、黄韧带（FL）和小关节囊（FC）根据损伤程度分为完整、血肿和撕裂,ISL又分为血肿比例＞50％和≤50％.最后分析AO形态学损伤的进行性等级与MRI信号之间的关系. 结果 AO A1/A2表现为单纯FC牵张损伤,A3出现ISL撕裂,范围较小,FL和SSL基本完整;AO B1表现为除FC损伤外,还有ISL血肿撕裂,SSL/FL损伤发生率较低,β2表现为SSL/FL损伤发生率明显增加;AO C表现为小关节脱位伴骨折,ISL、SSL、FL均会撕裂.AO骨折程度与MRI显示PLC损伤高度相关（P＜0.01）. 结论 MRI能很好显示PLC各单元的损伤情况及其损伤顺序.AO形态学分型与MRI紧密关联,随着创伤力量的增加,PLC各成分出现进行性损伤.

Objective To investigate the damage sequence of posterior ligamentous complex （PLC） and its clinical significance in thoracolumbar fracture.Methods Data of 132 patients with spinal fracture evaluated with X-rays,CT and short-tau inversion-recovery （STIR） sequences in MRI were collected prospectively.Fracture morphology was classified using the AO classification.PLC components including interspinous ligament （ISL）,supraspinous ligament （SSL）,ligamentum flavum （LF） and facet capsules （FC） were assessed and classified as intact,edema,or tear.ISL edema was further subdivided depending on the extension （〉 50% or ≤50%）.Correlation between MRI signal and AO progressive scale of morphological damage was analyzed.Results AO type A1/A2 fracture associated with only FC distraction.AO type A3 fracture showed additional ISL tear,usually less than 50%,with neither LF nor SSL tear.AO type B1 fracture showed FC distraction,ISL edema or disruption,and low rate of SSL/LF tear,but B2 fracture increased the rate of SSL/LF tear.AO type C fracture showed facet fracture or dislocation and ISL,SSL as well as LF tear.High correlation was found between AO progressive scale and MRI signal （P 〈 0.01）.Conclusions MRI study can well display the PLC damage and damage sequence.MRI correlates with AO progressive scale of morphological damage,which shows a progressive orderly rupture sequence among different PLC components as traumatic forces increase.