胸腰椎爆裂骨折后路内固定术后椎体空洞形成的危险因素与疗效分析

目的 观察胸腰椎爆裂骨折采用后路内固定复位术后椎体内空洞形态，分析空洞产生的危险因素及空洞对临床疗效的影响。 方法 选取胸腰椎爆裂骨折后路内固定复位术治疗患者52例，随访2年以上，观察椎体内空洞形态；将患者按椎体内有无明显空洞分为2组，对比两组临床和影像学特点，分析导致空洞的危险因素及空洞对临床疗效的影响。 结果 椎体完全愈合23.1%（12/52），存在空洞76.9%（40/52）。椎体空洞的形态有几种类型：终板空洞22.5%（9/40）；椎体空洞47.5%（19/40）；椎体劈裂30%（12/40）。椎体空洞组男性比例较高、脊髓神经损伤较严重。术后随访平均37.8个月，患者的腰痛及腰椎功能恢复良好，两组间VAS及ODI评分无统计学差异。 结论 胸腰椎爆裂骨折后路伤椎置钉复位术未行椎体植骨者容易导致椎体内空洞，骨折爆裂程度越高，越容易导致椎体空洞；实施伤椎螺钉置入术后椎体高度复位的程度较大是导致椎体中前部出现空洞的重要原因。椎体内出现空洞或劈裂，短期不影响患者的腰椎疼痛及功能。

Risk factors and clinical effect of vertebral cavity formation after posterior short-segmental fixation for thoracolumbar and lumbar burst fractures

Objective To observe the vertebral body healing pattern after posterior short-segmental fixation for thoracolumbar and lumbar burst fractures, and to analyze the risk factors and clinical effect of vertebral cavity. Methods Fifty-two patients with posterior short-segmental fixation for thoracolumbar burst fracture were followed up for at least 2 years. The CT results of the last follow-up were analyzed to observe the morphological characteristics of the cavity in the vertebral body. The patients with and without obvious cavities in the vertebral body were divided into two groups. The clinical and imaging characteristics of the two groups were compared, and the risk factors leading to the cavities were analyzed to observe whether the vertebral cavity affects the clinical efficacy or not. Results There were 12 cases of complete healing of vertebral body (accounting for 23.1%) and 40 cases of cavity (accounting for 76.9%). The shape of the cavity in the vertebral body could be divided into the following types: small cavity in the endplate (n=9, accounting for 22.5%), large cavity in the vertebral body (n=19, accounting for 47.5%), and split in the vertebral body (n =12, accounting for 30%). The proportion of males in the vertebral cavity group was higher, and the spinal cord nerve injury was more serious. An average follow-up of 37.8 months after surgery showed that the two groups of patients had good back pain and lumbar function, and there was no statistical difference in the VAS and ODI scores between the two groups. Conclusions Vertebral cavities are commonly seen after posterior short-segmental fixation for thoracolumbar and lumbar burst fractures. The higher degree of fracture rupture, the easier to cause the vertebral cavity. The large degree of the vertebral body anterior edge reduction after the operation of screw placement is an important cause of the cavity. Presence of a cavity in the vertebral body does not affect the patient’s lumbar pain and function in the short term.