实用骨科杂志
實用骨科雜誌
실용골과잡지
JOURNAL OF PRACTICAL ORTHOPEDICS
2014年
5期
389-393,463
,共6页
张志成%刘秀梅%李放%任大江%孙天胜
張誌成%劉秀梅%李放%任大江%孫天勝
장지성%류수매%리방%임대강%손천성
胸腰段损伤%后方韧带复合体%评估%脊髓损伤%后凸畸形
胸腰段損傷%後方韌帶複閤體%評估%脊髓損傷%後凸畸形
흉요단손상%후방인대복합체%평고%척수손상%후철기형
thoracolumbar injury%posterior ligamentous complex%evaluation%spinal cord injury%kyphosis
目的：分析胸腰段损伤椎体压缩、平移、椎管侵及、后凸畸形等骨性影像学参数与后方韧带复合体及神经损伤的相关性。方法回顾分析2012年1月至12月间的胸腰段损伤（T11~ L2）患者48例，排除骨质疏松性压缩骨折和病理性骨折患者。所有患者均具备 X 线片、CT 平扫及矢状位重建、MRI 检查。CT 正中矢状位片上测量局部后凸角、伤椎楔变角、伤椎前后壁高度、伤椎压缩率、棘突间距、椎体间平移距离、椎管前后径；轴位 CT 测量后壁骨折块突入椎管的距离，除以椎管前后径计算为椎管侵及率。根据 MRI 的表现将后方韧带复合体（posterior ligamentous complex，PLC）状态分为无损伤、不完全损伤、完全断裂。记录 ASIA 运动评分及 ASIA 残损分级。使用 Spearman 相关系数评估影像学参数、韧带损伤、神经损伤间的相关性。结果3例患者局部后凸角大于30°，4例患者椎体楔变角大于30°，6例局部后凸角大于20°，11例椎体楔变角大于20°。10例椎体压缩率大于50%，29例椎体间平移大于3.5 mm，6例棘突间距增大大于7 mm，12例椎管侵及率大于50%。根据 MRI 评估，17例患者存在 PLC 损伤。局部后凸角大于30°、椎体间平移大于3.5 mm、棘突间距增大大于7 mm 时，与 PLC 损伤存在有统计学意义的正相关性，而当椎体间平移大于2.5 mm、椎管侵及率大于50%时，与 AISA 残损分级和 ASIA 运动评分存在有统计学意义的负相关性。其他未见明显相关性。结论椎体间平移大于3.5 mm、局部后凸角大于30°、棘突间距增宽大于7 mm 通常合并 PLC 损伤，椎管侵及率大于50%及椎体间平移大于2.5 mm 时倾向于合并神经损伤。PLC 和神经组织的状态应直接通过 MRI 进行评估。
目的：分析胸腰段損傷椎體壓縮、平移、椎管侵及、後凸畸形等骨性影像學參數與後方韌帶複閤體及神經損傷的相關性。方法迴顧分析2012年1月至12月間的胸腰段損傷（T11~ L2）患者48例，排除骨質疏鬆性壓縮骨摺和病理性骨摺患者。所有患者均具備 X 線片、CT 平掃及矢狀位重建、MRI 檢查。CT 正中矢狀位片上測量跼部後凸角、傷椎楔變角、傷椎前後壁高度、傷椎壓縮率、棘突間距、椎體間平移距離、椎管前後徑；軸位 CT 測量後壁骨摺塊突入椎管的距離，除以椎管前後徑計算為椎管侵及率。根據 MRI 的錶現將後方韌帶複閤體（posterior ligamentous complex，PLC）狀態分為無損傷、不完全損傷、完全斷裂。記錄 ASIA 運動評分及 ASIA 殘損分級。使用 Spearman 相關繫數評估影像學參數、韌帶損傷、神經損傷間的相關性。結果3例患者跼部後凸角大于30°，4例患者椎體楔變角大于30°，6例跼部後凸角大于20°，11例椎體楔變角大于20°。10例椎體壓縮率大于50%，29例椎體間平移大于3.5 mm，6例棘突間距增大大于7 mm，12例椎管侵及率大于50%。根據 MRI 評估，17例患者存在 PLC 損傷。跼部後凸角大于30°、椎體間平移大于3.5 mm、棘突間距增大大于7 mm 時，與 PLC 損傷存在有統計學意義的正相關性，而噹椎體間平移大于2.5 mm、椎管侵及率大于50%時，與 AISA 殘損分級和 ASIA 運動評分存在有統計學意義的負相關性。其他未見明顯相關性。結論椎體間平移大于3.5 mm、跼部後凸角大于30°、棘突間距增寬大于7 mm 通常閤併 PLC 損傷，椎管侵及率大于50%及椎體間平移大于2.5 mm 時傾嚮于閤併神經損傷。PLC 和神經組織的狀態應直接通過 MRI 進行評估。
목적：분석흉요단손상추체압축、평이、추관침급、후철기형등골성영상학삼수여후방인대복합체급신경손상적상관성。방법회고분석2012년1월지12월간적흉요단손상（T11~ L2）환자48례，배제골질소송성압축골절화병이성골절환자。소유환자균구비 X 선편、CT 평소급시상위중건、MRI 검사。CT 정중시상위편상측량국부후철각、상추설변각、상추전후벽고도、상추압축솔、극돌간거、추체간평이거리、추관전후경；축위 CT 측량후벽골절괴돌입추관적거리，제이추관전후경계산위추관침급솔。근거 MRI 적표현장후방인대복합체（posterior ligamentous complex，PLC）상태분위무손상、불완전손상、완전단렬。기록 ASIA 운동평분급 ASIA 잔손분급。사용 Spearman 상관계수평고영상학삼수、인대손상、신경손상간적상관성。결과3례환자국부후철각대우30°，4례환자추체설변각대우30°，6례국부후철각대우20°，11례추체설변각대우20°。10례추체압축솔대우50%，29례추체간평이대우3.5 mm，6례극돌간거증대대우7 mm，12례추관침급솔대우50%。근거 MRI 평고，17례환자존재 PLC 손상。국부후철각대우30°、추체간평이대우3.5 mm、극돌간거증대대우7 mm 시，여 PLC 손상존재유통계학의의적정상관성，이당추체간평이대우2.5 mm、추관침급솔대우50%시，여 AISA 잔손분급화 ASIA 운동평분존재유통계학의의적부상관성。기타미견명현상관성。결론추체간평이대우3.5 mm、국부후철각대우30°、극돌간거증관대우7 mm 통상합병 PLC 손상，추관침급솔대우50%급추체간평이대우2.5 mm 시경향우합병신경손상。PLC 화신경조직적상태응직접통과 MRI 진행평고。
Objective To analyze the correlation of posterior ligamentous complex(PLC)and neurological injury with bony imaging parameters( vertebral compression,translation,spinal canal invasion,and kyphosis,etc)in thoracolumbar injury. Methods Retrospective analysis of consecutive 48 patients with thoracolumbar injury(T11 ~ L2 )between January-December in 2012 was performed. The osteoporotic compression fractures and pathologic fracture patients were excluded. All patients should have the tests of X-ray,CT scan and sagittal reconstruction,MRI scan. Local kyphosis,injured vertebral wedge angle, anterior and posterior injured vertebral heights,interspinous distance,vertebral translation,anteroposterior diameters of spinal canal were measured on midsagittal CT scan. The injured vertebral compression ratio was calculated. The distance of posterior wall fracture block broke into spinal canal were measured on axial CT scan and ratio of spinal canal invasion was calculated by dividing the spinal canal anteroposterior diameter. The status of the PLC based on MRI signals were recorded as intact,incom-plete injury,or disrupted. Their ASIA motor scores and ASIA Impaired Scale were recorded. Spearman correlation coefficients were analyzed to assess the correlation between bony imaging parameters,PLC injury,and neurological injury. Results There were 3 patients with local kyphosis ﹥ 30°,4 patients with injured vertebral wedge angle ﹥ 30°,6 patients with local kyphosis ﹥20°,11 patients with with injured vertebral wedge angle ﹥ 20°,10 patients with vertebral compression rate ﹥ 50% ,29 patients vertebral translation ﹥ 3. 5 mm,6 patients with interspinous distance increases ﹥ 7 mm,12 patients with spinal canal invasion ratio ﹥ 50% . According to MRI evaluation,17 patients had PLC injury. There were significant positive correlation between lo-cal kyphosis ﹥ 30°,vertebral translation ﹥ 3. 5 mm,interspinous distance increases ﹥ 7 mm and PLC injury. Significant negative correlations were found between vertetral translation ﹥ 2. 5 mm,spinal canal invasion ratio ﹥ 50% ,and neurological injury (AISA impaired Scale and ASIA motor score). There were no significant correlations between PLC injury or neurological injury and other bony imaging parameters. Conclusion Some thresholds for bony imaging parameters were not predictive of PLC and neurological injury. When vertebral translation ﹥ 3. 5 mm,local kyphosis ﹥ 30°,interspinous distantce increases ﹥ 7 mm,thora-columbar injury usually combine with PLC injury . Patient with spinal canal invasion ratio ﹥ 5 0 % and vertebral translation ﹥2. 5 mm tend to merge neurological injury. PLC and neurological structure status should be evaluated by MRI.
