胸腰椎爆裂骨折椎弓根钉预出钉点与椎前大血管距离变化的影像学研究

Distance between tip-point of lumbar pedicle screw and large blood vessels in front of vertebral body in patients with thoracolumbar fractures

目的探讨胸腰椎爆裂骨折椎弓根钉预出钉点与椎前大血管距离变化的影像学关系。方法回顾性分析自2005-04-2018-08采用椎弓根钉内固定治疗的108例胸腰椎爆裂骨折(骨折组)与正常体检的48例健康成年人(健康组),比较健康组与骨折组T_(11)~L_(4)左侧椎弓根出钉部位到主动脉后壁的距离(BE)、右侧椎弓根出钉部位到主动脉或下腔静脉的距离(BF),探讨伤椎Cobb角与骨折椎体BE值的相关性、骨折椎体BE值与骨折上下椎体BE值的相关性。结果Spear-man相关性分析结果显示骨折组伤椎Cobb角与骨折椎体BE值无相关性(P>0.05)。骨折组T_(12)~L_(4)BE值较健康组大,L_(2)、L_(3)BF值较健康组大,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示,骨折组骨折椎体BE值和骨折上椎体BE值呈正相关(P<0.05),骨折椎体BE值和骨折下椎体BE值呈正相关(P<0.05)。结论胸腰椎爆裂骨折后上下节段椎体与椎前大血管之间的距离有所增加,左侧出钉点至主动脉距离L_(3)、L_(4)节段较T_(11)、T_(12)节段增加明显,椎体右侧预出针点损伤大血管的风险较左侧低。椎体骨折后预出钉点至大血管的距离增加,椎弓根钉损伤椎前大血管的风险并不会增大。

Objective To study the change of the distance between the tip-point of pedicle screw and the large blood vessel in front of vertebral body in thoracolumbar fractures.Methods A retrospective analysis of 108 cases of thoracolumbar burst fractures treated with pedicle screw internal fixation(fracture group) and 48 healthy adults(health group) under normal physical examination from April 2005 to August 2018 was conducted.The distance from the left pedicle screw exit site of T11~L4 to the posterior wall of the aorta(BE) and the distance from the right pedicle screw exit site to the aorta or inferior vena cava(BF) were compared between the two groups.The correlation of the Cobb angle of the injured vertebrae with the BE value of vertebral body,as well as the correlation of the BE value of fractured vertebrae and the BE value of fractured upper and lower vertebrae were investigated.Results The results of Spearman correlation analysis showed that there was no correlation between the Cobb angle of the injured vertebra and the BE value of the fractured vertebra in the fracture group(P>0.05).The T12~L4 BE value of the fracture group was larger than that of the healthy group,and the difference was statistically significant(P<0.05).The L2 and L3 BF values of the fracture group were larger than those of the healthy group,and the difference was statistically significant(P<0.05).The results of Pearson correlation analysis showed In the fracture group,the BE value of the fractured vertebral body was positively correlated with the BE value of the upper fractured vertebral body(P<0.05),and the BE value of the fractured vertebral body was positively correlated with the BE value of the lower fractured vertebral body(P<0.05).Conclusion After thoracolumbar burst fractures,the distance between the upper and lower segments of the vertebral body and the prevertebral great vessels increased.The distance between the left screw exit point and the aorta at the L3 and L4 segments increased significantly compared with the T11 and T12 segments,and the risk of damaging large blood vessels at the pre-extracting needle point of the right side of the vertebral body is lower than that on the left side.After a vertebral body fracture,the distance from the pre-screw point to the large blood vessel increases,and the risk of pedicle screw injury to the anterior large blood vessel does not increase.