椎弓根钉内固定术治疗胸腰椎爆裂性骨折患者的影像学分析

Analysis on the Imaging of Vertebral Pedicle Wire Internal Fixation in the Treatment of Thoracolumbar Burst Fracture

目的观察并分析椎弓根针内固定术治疗胸腰椎爆裂性骨折患者的影像学特点。方法回顾性分析我院2012年10月至2014年10月接受椎弓根针内固定术治疗的胸腰椎爆裂性骨折患者74例,患者在治疗前后分别进行X线正侧位片和CT轴扫影像学分析,分析两种诊断方法对患者Denis分型及椎体前缘受压分度诊断的准确性,比较手术前后患者椎体前缘压缩率、椎体后缘压缩率、后凸畸形角(Cobb角)变化差异。结果经X线检查Denis分型诊断的准确性为86.49%较CT扫描95.95%显著较低(P<0.05);经X线诊断患者椎体前缘受压分度的准确性为81.08%较CT扫描显著较低(P<0.05);经椎弓根针内固定术治疗后患者的椎体前后压缩率与Cobb角较术前显著较低(P<0.05)。结论 X线和CT在胸腰椎爆裂性骨折检查中各具优势,X线能准确的显示出受损伤椎体的平面、范围和程度,而CT检查能更清晰的观察骨折细节,两种诊断方式相结合诊断的准确率越高;经影像学检查发现,椎弓根针内固定术治疗后患者伤椎椎体高度恢复并维持稳定,是治疗胸腰椎爆裂性骨折的有效方法。

Objective To observe and analyze imaging results of vertebral pedicle wire internal fixation in the treatment of thoracolumbar burst fracture. Methods A retrospective analysis of clinical data was carried out in 74 patients with thoracolumbar burst fracture who received vertebral pedicle wire internal fixation treatment of our hospital from October 2012 to October 2014, the features of the frontal and lateral X-ray films and CT in 74 patients were reviewed before and after the treatment, accuracy of two diagnostic methods to Denis parting and diagnosis of vertebral body leading edge compression index were analyzed, difference in the changes of compression ratio of vertebral body leading edge, compression ratio of vertebral body posterior margin, cobb angle before and after the operation were compared. Results Accuracy of Denis parting diagnosis by X-ray examination 86.49% was significantly lower than CT scan（95.95%）（P〈0.05）, accuracy of ertebral body leading edge compression index by X-ray diagnosis 81.08% was significantly lower than CT scan（P〈0.05）, compression ratio of anterior-posterior vertebra body and cobb angle after vertebral pedicle wire internal fixation were significantly lower than those before the operation（P〈0.05）. Conclusion X-ray and CT have their own edges in thoracolumbar burst fracture examination, X-ray can display plane, range and extent of injured vertebral bodies exactly, CT examination can observe details of fracture more clearly, accuracy of combination of the two diagnostic methods is higher; imaging examination shows that injured vertebral bodies height recovery and maintain stability after vertebral pedicle wire internal fixation treatment, is an effective method in the treatment of thoracolumbar burst fracture.