伴椎管侵占的A3型胸腰段椎体骨折影像学参数与后路间接减压效果的关系

Relationship between imaging parameters of type A3 thoracolumbar vertebral fracture withintracanal invasion and reduction effect of posterior indirect decompression

目的:分析伴椎管侵占的A3型胸腰段椎体骨折患者的影像学参数,探讨其与后路间接减压效果的关系.方法:回顾分析2020年7月~2022年7月收治的58例伴椎管侵占的A3型胸腰段椎体骨折患者的资料,患者均接受后路间接减压内固定手术治疗.根据术中椎管内骨折块复位程度分为复位组(45例)和复位不良组(13例),复位不良组加做半椎板切除椎管减压术.比较两组病例的骨折相关参数,包括术前伤椎椎体压缩比、术中伤椎高度恢复程度、术前节段后凸角、术前骨折块位于后壁的位置、术前骨折块翻转角度、术前椎管侵占率、术前骨折块高度与伤椎体后壁高度比值、术前骨折块宽度与伤椎椎管横径比值及术后神经功能恢复程度.多因素Logistic回归分析影响椎管内骨折块复位的危险因素.结果:复位组的术前伤椎椎体压缩比、节段后凸角及椎管侵占率分别为(34.98±6.06)%、20.64°±3.04°及(46.65±15.99)%,复位不良组分别为(43.20±12.80)%、24.80°±3.71°及(64.70±18.90)%,复位组均小于复位不良组,两组比较差异有统计学意义(P<0.05).复位组的术中伤椎高度恢复程度[(89.31±6.78)%]大于复位不良组[(65.87±4.67)%],差异有统计学意义(P<0.001).两组间术前骨折块翻转角度、骨折块位于后壁的位置、骨折块高度与伤椎体后壁高度比值、骨折块宽度与伤椎椎管横径比值及术后神经功能恢复程度比较均无统计学差异(P>0.05).多因素Logistic回归分析显示,术前伤椎椎体压缩比、节段后凸角、椎管侵占率及术中伤椎高度恢复程度是影响椎管内骨折块复位的危险因素.结论:对于伴椎管侵占的A3型胸腰段椎体骨折,术前伤椎椎体压缩比、节段后凸角、椎管侵占率及术后伤椎高度恢复程度是影响后路间接减压术后椎管内骨折块复位程度的重要参数.

Objectives:To analyze the imaging parameters of type A3 thoracolumbar vertebral fracture with intra-canal invasion,aand to explore their relationships with the reduction effect of intra-canal fracture fragment after posterior indirect decompression.Methods:A retrospective study was conducted on 58 patients of type A3 thoracolumbar vertebral fracture with intra-canal invasion treated with posterior indirect decompression and internal fixation in our hospital from July 2020 to July 2022.According to the degree of reduction of intra-canal fracture fragment during surgery,the patients were divided into reduced group(45 cases)and unreduced group(13 cases).Hemilaminectomy and spinal canal decompression were also performed in the unreduced group.Parameters of fracture were compared between the two groups,including preoperative injured vertebrae compression ratio,intraoperative recovery degree of vertebral height,preoperative local kyphosis angle,preoperative location of intra-canal fracture fragment,preoperative inversion angle of intra-canal fracture fragment,preoperative rate of spinal canal invasion,preoperative ratio of height of bone fragments occupying the posterior wall of the injured vertebral body,preoperative ratio of the width of bone fragment occupying the transverse canal diameter,and postoperative neurological recovery.Multivariate logistic regression analysis of risk factors affecting the reduction of intraspinal fracture blocks was performed.Results:The injured vertebral compression ratio,local kyphosis angle,and spinal canal invasion rate before operation in the reduced group were lower than those in the unreduced group,respectively[(34.98±6.06)%vs(43.20±12.80)%,20.64°±3.04°vs 24.80°±3.71°,(46.65±15.99)%vs(64.70±18.90)%],and the differences were statistically significant(P<0.05).The intraoperative recovery degree of vertebral height in the reduced group[(89.31±6.78)%]was bigger than that in the unreduced group[(65.87±4.67)%],with statistical significance(P<0.001).There were no significant differences between the two groups in inversion angle of intra-canal fracture fragment,location of intra-canal fracture fragment,ratio of height of bone fragments occupying the posterior wall of the injured vertebral body,ratio of the width of bone fragment occupying the transverse canal diameter,and postoperative neurological recovery(P>0.05).Multivariate logistic regression analysis showed that the preoperative injured vertebral compression ratio,kyphosis angle of the segment,spinal canal invasion rate,and intraoperative recovery degree of vertebral height were the risk factors affecting the reduction of intracanal fracture fragment.Conclusions:The preoperative injured vertebral compression ratio,kyphosis angle of the segment,spinal canal invasion rate,and postoperative recovery degree of injured vertebral height are important parameters that influence the degree of reduction in type A3 thoracolumbar fracture with intra-canal fracture fragment after posterior indirect decompression.