影响胸腰椎爆裂骨折间接复位的相关因素分析

Influencing factors for reposition of bone fragment in thoracolumbar burst fracture:analysis of 62 patients

目的明确在胸腰椎椎体爆裂骨折中正中椎管矢状径压缩比率、后突骨折块翻转角度对后突骨折块复位的影响。方法回顾性分析2010-2014年本科收治的62例单个胸腰椎椎体爆裂骨折患者的临床资料。根据患者术中C臂透视结果分为复位组34例和未复位组28例。骨折采用AO分型,神经损伤采用ASIA分级。根据术中测量伤椎平面椎管正中矢状径压缩比率、后突骨折块翻转角度并进行统计学分析。结果未复位组椎管正中矢状径压缩比率[(59.8±20.6)%]与复位组[(18.1±11.3)%]比较,差异有统计学意义(t=9.581,P<0.01);未复位组后突骨折块的翻转角度[(38.1±18.7)°]与复位组[(21.7±11.6)°]比较,差异有统计学意义(t=4.041,P<0.01)。Logistic回归分析结果显示,AO骨折分型(Wald=6.415,P<0.05)及椎管正中矢状径压缩比率(Wald=5.417,P<0.05)与后突骨折块复位有有关;ASIA分级(Wald=3.816,P>0.05)及术前骨折块翻转角度(Wald=0.421,P>0.05)与后突骨折块复位无关。结论椎管正中矢状径压缩比率及骨折的AO分型是胸腰椎爆裂骨折中后突骨折块能否复位的重要评估指标。

rotation angle of bone Objective To determine the effect of mid-sagittal canal compromise correlation and fragments on the reposition of bone fragment after thoracolumbar burst fracture. Methods A retrospective analysis was carried out on 62 patients with single thoracolumbar burst fracture admitted in our department from 2010 to 2014. According to the results of C-arm X-ray system during the operation, the patients were divided into the reposition group （n = 34） and non-reposition （n = 28 ）. The fractures were classified according to AO classification. Neurological status was evaluated according to the ASIA grade. The rotation angle of bone fragment and calculates the mid-sagittal canal compression ratio were analyzed. Results There were significant differences in the mid-sagittal canal compression ratio between the reposition group and the nonreposition [ （ 18.1 ± 11.3） % vs （59.8 ±20.6） %, t = 9. 581, P 〈 0.01 ], and in the rotation angles of bone fragments [ （38.1 ± 18.7）° vs （21.7 ± 11.6）°, t =4. 041, P 〈0.01 ]. Logistic regression analysis indicated that AO classification （Wald =6. 415, P 〈0.05） and mid-sagittal canal compression ratio （Wald = 5. 417, P 〈 0. 05） were correlated with the reposition of bone fragments, while ASIA grade （Wald =3. 816, P 〉0.05 ） had no such correlation. Conclusions AO classification and mid-sagittal canal compression ratio are predictors of assessing the reposition of bone fragments in the thoracolumbar fractures.