CAJ | 학술논문

背景:目前胸腰椎爆裂骨折在椎弓根器械复位固定后观察指标为椎体基本形态的影像学检查,对于复位后椎管形态变化的研究鲜有报道.目的:分析胸腰段椎体骨折予以椎弓根钉棒系统内固定复位治疗后椎管形态变化的规律.方法:对28例胸腰段椎体爆裂骨折予以椎弓根钉棒系统内固定复位的患者进行治疗后随访,所有患者分别于治疗前、治疗后1周,治疗后1年及治疗后2年拍胸腰椎正侧位X射线片,所有患者术前均行伤椎上下椎体的CT断层扫描,其中26例获得了治疗前、治疗后1周,及治疗后1年左右的CT横断扫描影像资料,2例部分影像学资料丢失.先于胸腰椎侧位X射线片上辨别椎体后缘有无骨折块突入椎管,同时观察椎体形态变化;CT横断扫描影像资料上测量椎管正中矢状径表示椎管占位程度.结果与结论:28例侧位X射线片上可看出椎体后缘骨块突入椎管者治疗前有18例(64.2%),治疗后6例(21.4%),治疗后1年时2例(7.1%),至治疗后2年1例(3.5%);治疗前正中矢状径平均为42.6%(n=28).有完整随访影像学资料的26例中治疗后CT片正中矢状径平均为75.2%(P <0.05),治疗后1年平均正中矢状径为91.2%(n=26).提示胸腰段椎体爆裂骨折行椎弓根钉棒系统内固定及复位治疗后椎管占位复位作用明显,治疗后远期观察椎管形态基本可恢复正常.
배경:목전흉요추폭렬골절재추궁근기계복위고정후관찰지표위추체기본형태적영상학검사,대우복위후추관형태변화적연구선유보도.목적:분석흉요단추체골절여이추궁근정봉계통내고정복위치료후추관형태변화적규률.방법:대28례흉요단추체폭렬골절여이추궁근정봉계통내고정복위적환자진행치료후수방,소유환자분별우치료전、치료후1주,치료후1년급치료후2년박흉요추정측위X사선편,소유환자술전균행상추상하추체적CT단층소묘,기중26례획득료치료전、치료후1주,급치료후1년좌우적CT횡단소묘영상자료,2례부분영상학자료주실.선우흉요추측위X사선편상변별추체후연유무골절괴돌입추관,동시관찰추체형태변화;CT횡단소묘영상자료상측량추관정중시상경표시추관점위정도.결과여결론:28례측위X사선편상가간출추체후연골괴돌입추관자치료전유18례(64.2%),치료후6례(21.4%),치료후1년시2례(7.1%),지치료후2년1례(3.5%);치료전정중시상경평균위42.6%(n=28).유완정수방영상학자료적26례중치료후CT편정중시상경평균위75.2%(P <0.05),치료후1년평균정중시상경위91.2%(n=26).제시흉요단추체폭렬골절행추궁근정봉계통내고정급복위치료후추관점위복위작용명현,치료후원기관찰추관형태기본가회복정상.
@@@@BACKGROUND: At present, the observation index of the thoracolumbar burst fracture after pedicle instrument reset is the imaging examination of vertebral body basic form, and the reports on the changes of morphology of spinal canal after reduction are rare. OBJECTIVE: To analyze the changes of morphology of spinal canal after thoracolumbar fractures treated with pedicle screw rod system fixation and reduction. METHODS: Twenty-eight cases of thoracolumbar burst fracture treated with pedicle screw rod system fixation and reduction were fol owed-up after operation, and al patients took the thoracolumbar anteroposterior and lateral X-ray film before treatment, 1 week, 1 and 2 years after operation. Al the patients underwent CT scans of the upper and lower vertebral body, of which 26 patients obtained the image data of CT scan before treatment, 1 week, 1 and 2 years after operation, and partial image information of two patients lost. Whether the fracture block of the posterior margin of vertebral body went into the spinal canal or not was identified on the thoracic and lumbar spine lateral X-ray film firstly, and the changes of spinal canal morphology were observed; the spinal median sagittal diameter measured based on the CT scanning image data represented the spinal space-occupying degree. RESULTS AND CONCLUSION: Lateral X-ray films of the 28 cases showed the fracture block of the posterior margin of vertebral body of 18 cases (64.2%) went into the spinal canal before operation, fracture block of six cases (21.4%) went into the spinal canal after operation, two cases (7.1%) at 1 year after operation, one cases (3.5%) at 2 years after operation; the average spinal median sagittal diameter was 42.6% (n=28) before operation. The spinal median sagittal diameter of the 26 cases with complete fol ow-up imaging data was 75.2% (P < 0.05), and the median sagittal diameter at 1 year after operation was 91.2% (n=26). The occupying reduction effect of spinal canal is obvious after thoracolumbar burst fracture treated with pedicle screw rod system fixation and reduction, the postoperative long-term observation shows the spinal canal morphology can be restored to normal.