CAJ | 학술논문

目的对Denis B型胸腰椎爆裂骨折时伤椎椎弓根断裂情况、伤椎压缩程度进行影像学观察,并分析其发生的关联性因素.方法收集2007年9月至2014年5月收治的Denis B型胸腰椎爆裂骨折患者的资料共211例,统计的指标包括:年龄、性别、诊断、发生节段、脊髓损伤美国脊髓损伤协会(ASIA)分级、影像学资料(CT及正、侧位X线片).分析椎弓根断裂情况(椎弓根完整、单侧断裂、双侧断裂)、伤椎压缩程度(压缩≤1/2、＞1/2)与性别、年龄、发生节段、脊髓损伤ASIA分级的关系.结果 Denis B型胸腰椎爆裂椎体215节段,其中完整椎弓根、单侧椎弓根断裂、双侧椎弓根断裂分别有134(62.3％)、60(27.9％)、21(9.8％)节段;伤椎压缩程度≤1/2、＞1/2分别有156(72.6％)、59(27.4％)节段.伤椎压缩≤1/2时椎弓根断裂发生率为18.9％,伤椎压缩＞1/2时椎弓根断裂发生率为36.4％;性别、年龄段、损伤节段在椎弓根断裂情况、伤椎压缩程度的分布差异均无统计学意义(P＞0.05).脊髓损伤ASIA分级在椎弓根断裂分布差异有统计学意义(P=0.020),且椎弓根断裂越严重,脊髓损伤越严重,存在线性相关(x2=12.190,P=0.000,Spearman等级相关系数=0.187,P=0.006);脊髓损伤ASIA分级在伤椎压缩程度分布差异无统计学意义(x2=3.523,P=0.318),脊髓损伤ASIA分级在椎弓根断裂情况联合椎体压缩程度的分布差异有统计学意义(x2=0.422,P=0.001). 结论性别、年龄段、节段分布与椎弓根断裂及伤椎压缩程度无关;但伤椎压缩程度越大,椎弓根断裂越严重;椎弓根断裂越严重,脊髓损伤越严重.
목적 대Denis B형흉요추폭렬골절시상추추궁근단렬정황、상추압축정도진행영상학관찰,병분석기발생적관련성인소.방법 수집2007년9월지2014년5월수치적Denis B형흉요추폭렬골절환자적자료공211례,통계적지표포괄:년령、성별、진단、발생절단、척수손상미국척수손상협회(ASIA)분급、영상학자료(CT급정、측위X선편).분석추궁근단렬정황(추궁근완정、단측단렬、쌍측단렬)、상추압축정도(압축≤1/2、＞1/2)여성별、년령、발생절단、척수손상ASIA분급적관계.결과 Denis B형흉요추폭렬추체215절단,기중완정추궁근、단측추궁근단렬、쌍측추궁근단렬분별유134(62.3％)、60(27.9％)、21(9.8％)절단;상추압축정도≤1/2、＞1/2분별유156(72.6％)、59(27.4％)절단.상추압축≤1/2시추궁근단렬발생솔위18.9％,상추압축＞1/2시추궁근단렬발생솔위36.4％;성별、년령단、손상절단재추궁근단렬정황、상추압축정도적분포차이균무통계학의의(P＞0.05).척수손상ASIA분급재추궁근단렬분포차이유통계학의의(P=0.020),차추궁근단렬월엄중,척수손상월엄중,존재선성상관(x2=12.190,P=0.000,Spearman등급상관계수=0.187,P=0.006);척수손상ASIA분급재상추압축정도분포차이무통계학의의(x2=3.523,P=0.318),척수손상ASIA분급재추궁근단렬정황연합추체압축정도적분포차이유통계학의의(x2=0.422,P=0.001). 결론 성별、년령단、절단분포여추궁근단렬급상추압축정도무관;단상추압축정도월대,추궁근단렬월엄중;추궁근단렬월엄중,척수손상월엄중.
Objective To investigate the roles of pedicle fracture and vertebral compression in thoracolumbar burst fractures of Denis type B.Methods A total of 211 patients with burst fracture of Denis type B were reviewed who had been treated at our department from September 2007 to May 2014.They were analyzed in terms of age,gender,diagnosis,fractured segmental level,ASIA (American Spinal Injury Association) grade of spinal cord injury,and preoperative imaging data (spinal CT and anteroposterior and lateral X-ray films).The associations of pedicle fracture (intact pedicle,unilateral and bilateral pedicle fractures) and vertebral compression (≤1/2 versus ＞ 1/2) with age,gender,fractured segmental level and ASIA grade were analyzed statistically.Results Of all the 215 fractured segments of Denis type B,134 had intact pedicle (62.3％),60 unilateral pedicle fracture (27.9％),and 21 bilateral pedicle fracture (9.8％).156 segments (72.6％) had ≤ 1/2 vertebral compression and 59 ＞ 1/2 compression (27.4％).The incidence of pedicle fracture was 18.9％ in cases of ≤1/2 vertebral compression and 36.4％ in cases of ＞ 1/2 compression.Age,gender,and fractured segmental level had no significant effects on either pedicle fracture or vertebral compression (P ＞ 0.05).ASIA grade had a significant effect on pedicle fracture (P =0.020) and there was a linear association between ASIA grade and pedicle fracture (x2 =12.190,P=0.000;Spearman rank correlation coefficient =0.187,P =0.006).ASIA grade had no significant effect on vertebral compression (x2 =3.523,P =0.318).ASIA grade had a significant effect on pedicle fracture combined with vertebral compression (x2 =0.422,P =0.001).Conclusions Gender,age and fractured segmental level may have an insignificant impact on pedicle fracture or vertebral compression.The greater a vertebral compression,the more serious a pedicle fracture.The more serious a pedicle fracture,the more severe a spinal cord injury.