MSCT及MRI在胸腰椎爆裂型骨折的临床应用价值分析

目的 探讨多层螺旋CT（MSCT）及磁共振成像（MRI）在胸腰椎爆裂型骨折中的临床应用价值.方法 回顾性分析52例胸腰椎爆裂型骨折临床、影像学资料,所有患者均行MSCT及MRI检查,比较两者诊断结果,分析骨折合并脊髓、韧带及椎间盘损伤等情况MSCT、MRI表现.结果 52例中,椎管内骨折片的显示MSCT优于MRI（49个比40个,P＜0.05）;韧带、脊髓及椎间盘等软组织损伤的显示MRI均优于MSCT,MRI发现韧带损伤15例,MSCT 1例（P＜0.01）;脊髓损伤CT检出6例,MRI 25例（P＜0.01）;椎间盘损伤MSCT检出5例,MRI 39例（P＜0.01）.结论 脊柱损伤应常规行MSCT检查,MRI应作为韧带、脊髓损伤的首选检查.胸腰椎爆裂型骨折尤其存在不稳定骨折者,应同时选用MSCT和MRI检查.     

强直性脊柱炎脊柱骨折的影像学表现

目的 探讨强直性脊柱炎(AS)脊柱骨折的多种影像学特征和影像诊断的价值.方法 回顾性分析20例AS合并脊柱骨折患者的影像学和临床资料.结果 损伤节段位于颈椎5例(25.00%),胸腰椎15例(75.00%),其中屈曲型损伤11例(55.00%),屈曲过伸型损伤9例(45.00%),前中后三柱同时损伤14例(70.00%),伴脊髓损伤8例(40.00%).X线平片共发现脊柱损伤征象43个,多层螺旋CT(MSCT)发现93个,MRI发现102个.结论 AS脊柱骨折常表现为累及三柱的贯通性骨折,MRI和MSCT是早期诊断的重要手段,MRI显示脊髓损伤和后柱损伤有明显优势,是评估AS合并脊柱骨折的首选影像学检查方法.     

经后路椎管侧前方潜行减压椎体内植骨内固定治疗胸腰椎骨折

目的探讨对不稳定性爆裂型、骨折片侵及椎管容积〉50％的胸腰椎脊柱脊髓损伤患者,经后路椎管侧前方潜行减压椎体内植骨内固定治疗的可行性及临床效果．总结技术要点。方法对39例不稳定性爆裂型、骨折片侵及椎管容积〉50％的胸腰椎骨折伴脊髓损伤患者行后路椎管侧前方潜行减压、椎体内及后外侧植骨、椎弓根螺钉内固定术。结果39例患者均获随访,随访7—41月,平均（14．22±7．41）月。椎体前缘高度与原高度比由术前平均（48．42±5．38）％恢复到术后平均（92．23±2．49）％;椎体后缘高度与原高度比由术前平均（74．31±3．56）％恢复到术后平均（97．76±1．06）％;Cobb角由术前平均（19．47±3．94）。矫正到术后平均（3．96±1．87）°．手术治疗前后比较均有明显好转,差异均有统计学意义（t分别=48．62、39．40、22．24,P均〈0．05）。神经功能根据Frankel分级评定,术后较术前有0～3级的恢复。其椎体高度无明显丢失,植骨全部融合,术后39例CT复查显示椎管矢状径得到有效扩大．脊髓压迫解除。结论经后路椎管侧前方潜行减压椎体内植骨内固定治疗不稳定性爆裂型、骨折片侵及椎管容积〉50％的胸腰椎骨折是可行的。     

胸腰段爆裂骨折的影像异常与神经损伤的关系

目的观察分析胸腰段爆裂骨折患者神经损伤是否存在及严重程度与以下因素的关系：①就诊时CT表现的椎管内骨块占位程度;②后凸畸形程度,评价后路经椎弓根器械治疗对恢复以下临床指标的效果：①伤椎前缘、后缘高度;②后凸成角;③神经功能;④椎管骨块占位。方法本组为99例胸腰段爆裂骨折患者,其中男71例,女28例;年龄17—68岁,平均37岁;致伤原因高处坠落57例,车祸2,4例,砸伤12例,其它6例;非手术治疗2例,除1例行单纯后路椎板减压外,余96例均行后路手术经椎弓根镙钉器械治疗,手术时间为伤后6小时-24天,术中出血为50ml-2000ml。所有患者入院时均行术前CT扫描、术前正侧位x线片,其中有7例有术后CT,非手术治疗和单纯后路椎板减压患者无术后x线片。所有影像资料都包括伤椎及与之相邻的上下椎体。受伤部位T11为5例、T12为15例、L1为53例、L2为26例。脊髓功能的评估以入院时首次体检（非手术治疗）或术前最后一次体检（手术治疗）为准,尽可能排除脊髓震荡所致的短暂脊髓功能障碍,术后以出院前最后一次体检为准。按修改的ASIA分级法进行评分,其中A级13例,B级7例,c级13例,D级29例,E级14例,F级23例。结果神经损伤按修改后的ASIA分级,各功能级之间椎管占位程度和后凸成角均无显著差异（P〉0．05）,术后伤椎前缘高度恢复至（91．4±10．0）％,后缘高度恢复至（96．7±4．4）％,Cobb角恢复至（-2．0±5．6）°,椎管内占位恢复至（14．6±13．8）％,神经功能评分降至（1．5±1．6）,以上各项指标与术前比较差异有显著性（P〈0．05）。结论①胸腰段爆裂骨折神经损伤是否存在及严重程度与就诊时CT表现的椎管内骨块占位程度和后凸畸形程度均具有不一致性,对于胸腰椎爆裂性骨折的早期治疗选择,不仅要考虑?     

A biomechanical investigation of thoracolumbar burst fracture under vertical impact loads using finite element method

BackgroundA sudden vertical impact load on spine can cause spinal burst fracture, especially in the thoracolumbar junction region. This study aimed at investigating the mechanism of spinal burst fracture under different energy vertical impact loads, producing the failure risk region to understand burst fracture, reducing nervous system damage and guiding clinical treatment.MethodsA nonlinear finite element model of T12-L1 motion segment was created to analyze the response of the vertical impact load. A rigid ball was used to impact the segment vertically to simulate the vertical impact load in practice. There were three different mass balls to represent the different loads: low energy, intermediate energy and high energy (respectively 13 J, 30 J and 56 J). The results of impact force, vertical displacement, stress, intradiscal pressure and contact force were obtained during the process.FindingsAt low energy condition, the rigid ball rebounded rapidly. At intermediate energy condition, fractures were initiated in vertebral foramen and left rear regions on the superior cortical bone near the superior endplate of L1. At high energy condition, burst fracture occurred and a part of L1 was isolated from the model.InterpretationThe fracture occurred on the L1 segment only at the intermediate energy and high energy. The strength of vertebral body under low and intermediate energy was enough to support the impact. The burst fracture pattern at high energy was also observed in clinical practice. The findings may explain the mechanism of burst fracture.     

胸腰段椎体爆裂骨折伴脊髓损伤的治疗

目的：探讨胸腰椎爆裂骨折伴脊髓损伤的最佳治疗。方法：分析56例外伤性胸腰段爆裂骨折伴脊髓损伤的临床资料。结果：术后疗效观察显示，50例脊髓神经功能有不同程度改善，术后椎体高度恢复，Z-plate 93.3,RF 92.6%、Dick 76.2%、Seffee 73.5%。结论：胸腰段椎体骨折复位Z－Plate、RF均较Dick、Steffee内固定效果好，RF操作方便、创伤小、风险少、费用低，适合绝大多数病人使用。脊髓损伤治疗强调在争取手术时间、整复脊柱骨折和椎管减压的同时，积极综合治疗。     

椎弓根钉置入治疗胸腰椎骨折

背景：近年来,随着医学、生物力学的发展以及各种各样新型内固定器械和方式的涌现,椎弓根钉置入内固定已成为治疗胸腰椎骨折的常用手段。 目的：闸述椎弓根钉仵胸腰椎骨折置入内固定治疗的研究与应用进展。 方法：检索胸腰椎骨折与椎弓根钉茕入内同定相关的研究文献,检索词为“胸腰椎骨折（thoracolumbarfracture）：内固定（internalfixation）：椎弓根（pedicle）：螺钉（SCREW）：椎弓根钉（pediclescrews）”,语言分别设定为中文和英文。从胸腰椎骨折分类系统,椎弓根钉临床应用进展和椎弓根钉固定系统特点3方面进行总结,对椎弓根钉胃入内吲定治疗胸腰椎骨折进行深入探讨分析。 结果与结论：椎弓根钉固定是一种有效的胸腰椎内固定技术,可用于各种原因引起的胸腰椎不稳,特别是胸腰椎骨折的治疗。椎弓根钉固定可以矫正畸形和维持脊柱的三维位置,提供较好的生物力学稳定性。椎弓根钉内固定系统能有效重建椎体高度,恢复生理曲度,并解除脊髓神经的压迫羊¨恢复受损椎管的管径,晕建脊柱的稳定性,纠正后凸畸形,临床上已广泛应用,具有创伤小、复位满意、固定坚强、操作简便等优点。     

无神经症状单节段胸腰椎爆裂型骨折行后路短节段椎弓根螺钉内固定置入186例

背景:胸腰椎骨折治疗方法众多,但是对于无神经症状的爆裂型骨折,采用简单的手术方法治疗,是否在减少创伤的同时能够取得较好的疗效,从而避免手术的扩大化尚不清楚.目的:观察采用单纯后路短节段椎弓根螺钉系统置入治疗无神经症状的单节段胸腰椎爆裂型骨折的疗效.方法:选择2003-09/2008 01苏州大学附属第一医院骨科收治的无神经症状单节段胸腰椎爆裂型骨折患者186例,男152例,女34例,年龄18-65岁.均采用单纯后路短节段椎弓根螺钉内固定置入治疗,椎管内骨块占位采用间接复位.于置入前、置入后及置入后1年余取内固定前摄以伤椎为中心的X射线正侧位片和CT,对X射线平片和CT进行测量,统计伤椎前缘高度、伤椎横截面积内骨块的占有率.结果与结论:伤椎前缘置入前高度平均为正常的42%,术后为98%,内固定取出术前伤椎前缘高度为正常高度的98%.伤椎横截面积内骨块占有率,术前平均为34%,术后平均为13%,内固定取出术前为8%.提示应用后路短节段椎弓根螺钉系统治疗无神经症状的胸腰椎爆裂型骨折,能够提供脊柱足够的稳定性,有效恢复椎体高度、生理弧度和椎管容积.     

miR-338-5p Levels and Cigarette Smoking are Associated With Neuropathic Pain Severity in Individuals With Spinal Cord Injury: Preliminary Findings From a Genome-Wide microRNA Expression Profiling Screen

ObjectiveTo identify microRNA biomarkers and clinical factors associated with neuropathic pain after spinal cord injury.DesignCross-sectional, secondary analysis of baseline data collected from ongoing clinical studies. Using a genome-wide microRNA screening approach, we studied differential microRNA expression in serum from 43 adults with spinal cord injury enrolled in ongoing clinical studies. Least squares regression was used to identify associations between microRNA expression, clinical factors, and neuropathic pain severity.SettingCommunity-dwelling individuals with spinal cord injury.ParticipantsParticipants (N=43) were at least 18 years old with spinal cord injury, with 28 reporting neuropathic pain and 15 reporting no neuropathic pain.InterventionsNot applicable.Main Outcome MeasuresPain presence, type, and intensity were assessed with the International Spinal Cord Injury Pain Basic Data Set. Serum microRNA normalized deep sequencing counts were quantified from blood samples. Participant demographic factors, injury characteristics, medication use, and health habits were collected via questionnaire.ResultsmiR-338-5p expression and history of cigarette smoking were associated with and explained 37% of the variance in neuropathic pain severity (R²=0.37, F_2,18=5.31, P=.02) independent of other clinical factors. No association was identified between miR-338-5p levels and nociceptive pain severity.ConclusionsOur findings suggest that miR-338-5p and cigarette smoking may both play a role in the development or maintenance of neuropathic pain after spinal cord injury. While additional work is needed to confirm these findings, validated target analysis suggests a neuroprotective role of miR-338-5p in modulating neuroinflammation and neuronal apoptosis and that its downregulation may result in maladaptive neuroplastic mechanisms contributing to neuropathic pain after spinal cord injury.     

椎弓根螺钉置入内固定治疗胸腰段骨折脱位后脊柱的生物力学变化

背景：对于胸腰段椎体爆裂性或粉碎性骨折,临床多行前路减压、植骨融合、钢板螺钉置入内固定。后路手术包括椎板切除减压、椎弓根螺钉置入内固定。 目的：探讨椎弓根螺钉置入内固定系统治疗胸腰段骨折脱位后脊柱的生物与力学变化。 方法：胸腰段骨折脱位的患者46例,给予椎弓根螺钉置入内固定系统治疗,观察内固定前后、当时及随访1年后脊髓损伤恢复情况及骨折复位情况。 结果与结论：46例患者均获得随访,采用Frankel功能分类法评估脊髓损伤的分级,各时期A级所占百分比差异无显著性意义（P 〉0.05）,螺钉置入内固定后当时及随访1年后B-E级与内固定前比较,均有显著性意义（P 0.05）。采用前缘高度百分比、后缘高度百分比、Cobb角等指标评估骨折复位情况,各时期后缘高度比较,差异无显著性意义（P 〉0.05）,螺钉置入内固定后当时及随访1年后的前缘高度、Cobb角与内固定前比较,差异均有显著性意义（P 0.05）。说明针对胸腰段骨折脱位的患者实施椎弓根置入内固定系统治疗,有利于骨折复位及脊髓神经功能恢复。     

198例四川地震中脊柱脊髓损伤的临床分析

目的分析四川地震脊柱脊髓损伤类型构成情况及临床特点。方法将198例伤员按照年龄段分为4组,收集骨折类型、神经损害程度、复合伤及多个部位脊柱骨折的数据,分析其临床特点。结果骨折类型以压缩骨折最多见(占49.3%),其次是爆裂骨折(占45.9%)。198例伤员中,脊髓损伤105例,ASIA分级：A级20例,B级18例,C级25例,D级42例。发生复合伤41例。发生多个椎体损伤的部位以T₁₂、L₁、L₂最多见。结论四川地震脊柱损伤类型以压缩骨折和爆裂骨折为主,主要集中在18～65岁年龄段,脊髓损伤占脊柱损伤的53.03%。     

Prehospital clinical findings associated with spinal injury

Objective. The objective of this study was to identify clinical findings that are associated with spinal fracture and/or spinal cord injuries in prehospital trauma patients.

Methods. A retrospective chart review was performed at three tertiary referral centers in Southeastern Michigan. All charts of patients with spinal fractures or spinal cord injuries during 1992 and 1993 were reviewed. Patients with available pre-hospital records were included in the study analysis. Prehospital data points included documentation of head injury; altered mental status; neurologic deficit; evidence of intoxication; cervical, thoracic, and lumbar pain or tenderness; nonspecified back pain or tenderness; and a narrative for all other documented injuries. Hospital data collected included type and level of spinal injury and age and sex of the patient.

Results. Of 867 injury patients identified, 536 were excluded, leaving 346 analyzable fractures in 331 patients. The 346 spinal fractures/spinal cord injuries were distributed as: 100 (29%) cervical, 83 (24%) thoracic, 128 (37%) lumbar, and 35 (10%) sacral. Prehospital documentation of altered mental status, neurologic deficit, evidence of intoxication, spinal pain, or suspected extremity fracture was found for every patient with a cervical injury, 82/83 patients with thoracic injuries (99%), and 124/128 patients with lumbar injuries (97%). All five patients who were not documented as having one of the predictors had stable injuries.

Conclusion. Prehospital clinical findings of altered mental status, neurologic deficit, evidence of intoxication, spinal pain, and suspected extremity fracture were documented for all patients with significant spinal injuries in this series. These findings may be useful to identify patients who require prehospital spinal immobilization.     

不同入路方式减压内固定术治疗合并脊髓受损的胸腰椎爆裂性骨折患者的疗效研究

目的分析不同入路方式减压内固定术治疗合并脊髓受损的胸腰椎爆裂性骨折患者的疗效。方法选取78例合并脊髓受损的胸腰椎爆裂性骨折患者。根据手术入路方式分为A组40例(前入路组)和B组38例(后入路组)。比较2组患者的一般资料、手术基本情况、手术前后的后凸Cobb角、伤椎高度及Frankel分级情况。结果 A组患者的植骨融合时间较B组显著更短(P0.05),而手术时间、住院时间及术中出血量均无显著差异(P0.05)。与术前相比,术后1周2组患者的伤椎高度及后凸Cobb角及术后12个月的Frankel分级情况均显著改善(P0.05),但同时点2组患者的伤椎高度、后凸Cobb角、Frankel分级均无显著差异(P0.05)。结论在合并脊髓受损的胸腰椎爆裂性骨折患者的治疗中,前、后入路减压内固定术治疗效果相当,但前入路术的植骨融合时间更短,后凸Cobb角丢失更少。     

Review article: Indications for thoracolumbar imaging in blunt trauma patients: A review of current literature

Thoracolumbar spine injury is a common complication of blunt multitrauma and up to one third of fractures are associated with spinal cord dysfunction. Delayed fracture diagnosis increases the risk of neurological complications. While validated screening guidelines exist for traumatic c‐spine injury equivalent guidelines for thoracolumbar screening are lacking. We conducted a literature review evaluating studies of thoracolumbar injury in trauma patients to generate indications for thoracolumbar imaging. We performed MEDLINE and Pubmed searches using MeSH terms “Wounds, Nonpenetrating”, “Spinal Fractures”, “Spinal Injuries” and “Diagnostic Errors”, MeSH/subheading terms “Thoracic Vertebrae/injuries” and “Lumbar Vertebrae/injuries” and keyword search terms “thoracolumbar fractures”, “thoracolumbar injuries”, “thoracolumbar trauma”, “missed diagnoses” and “delayed diagnoses”. Limits and inclusion criteria were defined prior to searching. We evaluated 16 articles; 5 prospective observational studies (1 cohort study) and 11 retrospective observational studies. Predictors of TL injury in prospective studies – high‐risk injury mechanism, distracting injury, impaired cognition, symptoms/signs of vertebral fracture and known cervical fracture – were defined and used to construct a decision algorithm, which in a total of 14189 trauma patients from all eligible studies recommended TL screening in 856(99.1%) of 864 patients with TL fractures and would probably have directed TL imaging in the remaining 8 patients. There is limited low level evidence guiding surveillance TL imaging in adult blunt trauma patients. Despite this, we propose and evaluate an algorithm with a high negative predictive value for TL fractures. This should be incorporated into spinal injury assessment protocols.     

伴不全瘫胸腰段椎体骨折的治疗(附112例疗效分析)

目的探讨伴不全瘫胸腰段椎体骨折的手术及非手术治疗效果及损伤复位机制、最佳治疗方法和手术内固定方式.方法本组伴不全瘫胸腰段椎体骨折112例行手术或非手术治疗.A组(非手术组)38例,过伸位牵引复位后平卧于硬板床.B组(手术组)74例,经前路或保留后结构的后路减压内固定.结果本组病例获随访时间3～12年,平均5.5年.治疗后随访伤椎前、后高度及后凸成角和椎管矢状径均较治疗前有显著改善(P＜0.01),而手术治疗组比非手术治疗组改善更明显.治疗后随访脊髓神经功能较治疗前有明显好转(P＜0.05),而手术治疗组效果更显著.结论伴脊髓损伤的胸腰段椎体骨折存在潜在性不稳定,有可能加重脊髓神经损伤或妨碍脊髓神经功能恢复,应尽可能早期行保留后结构后路手术减压内固定,以恢复脊柱序列及椎管容积.     

Thoracolumbar burst fracture: Evaluating stability

The burst fracture is an injury characterized by anterior vertebral body height loss and retropulsion of the posterior aspect of the vertebral body into the spinal canal. The vertebral body injury frequently is associated with fractures through the neural arch. Using a three-column concept of spinal stability, the division of these fractures into stable and unstable injuries is difficult. Radiographic signs of instability include widening of the interspinous and interlaminar distance, translation of more than 2 mm, kyphosis of more than 20 degrees, dislocation, height loss of more than 50%, and articular process fractures. However, fractures may be unstable in the absence of these signs. Unrecognized supraspinous ligament disruption contributes to this instability. This structure is best evaluated by MR examination. Confirmation of posterior ligamentous disruption occurring in conjunction with the burst fracture leads to reevaluation of the presumed mechanism of injury. This article discusses the many issues surrounding the division of burst fractures into stable and unstable injuries and reexamines the common classification systems of thoracolumbar spine injuries.     

In silico investigation of vertebroplasty as a stand-alone treatment for vertebral burst fractures

BackgroundThe use of percutaneous vertebroplasty as a stand-alone treatment for stable vertebral burst fractures has been investigated in vitro and in clinical studies. These studies present inconsistent results on the mechanical response of vertebroplasty-treated burst fractures. In addition, observations of the loss of sagittal alignment after vertebroplasty raise questions on the applicability of vertebroplasty for burst fractures. Therefore, the aim of this study was to investigate the mechanical stability of burst fractures after stand-alone treatment by vertebroplasty.MethodsFinite element simulations were performed with models generated from two laboratory-induced burst fractures in human thoracolumbar specimens. The burst fracture models were virtually injected with various cement volumes using a unipedicular or bipedicular approach. The models were subjected to four individual loads (compression, lateral bending, extension and torsion) and a multi-axial load case in the physiological range.FindingsAll treated burst fractures showed improvements in stiffness and a reduction in inter-fragmentary displacements, thus potentially providing a suitable mechanical environment for fracture healing. However, large volumes of the trabecular bone (< 43%), cement (< 53%) and bone–cement composite (< 58%) were predicted to experience strain levels exceeding the yield point. While damage was not specifically modeled, this implies a potential collapse of the treated vertebra due to local failure.InterpretationTo improve the primary stability and to prevent the collapse of treated burst fractures, the use of posterior instrumentation is suggested as an adjunct to vertebroplasty.     

胸腰椎爆裂型骨折并截瘫患者术后脊髓功能恢复与手术方式及内固定系统的相关性

背景胸腰椎爆裂型骨折的主要危害是原发和/或继发性损伤所造成的脊髓神经损伤,有报道经后路器械复位内固定对爆裂骨折的复位和对椎管的间接减压是有效的.目的探讨经前路减压后应用史塞克胸腰椎前路钢板内固定系统治疗胸腰椎爆裂型骨折并截瘫患者,改善术后椎管狭窄及脊柱力线的效果.设计病例报告.单位一所市级医院骨科.对象选择2001-09/2002-02东莞市太平人民医院骨科收治的胸腰椎爆裂型骨折并脊髓功能障碍患者5例,男4例,女1例;年龄17～34岁.方法对5例患者进行前路彻底减压,取髂骨或/和肋骨行椎间植骨,应用史塞克胸腰椎前路钢板内固定系统进行复位、内固定.于术后1,3,5,9个月拍X射线片,观察植骨融合情况、椎管狭窄面积及后凸角改善效果;随访时采用Frankel分级评定脊髓功能(A级为差,E级为优).主要观察指标①手术前后脊髓功能Frankel分级.②后凸成角情况及椎管狭窄面积.结果5例患者均进入结果分析.随访时间8个月.①椎间植骨全部完全融合,融合时间平均4个月.②Frankel分级除1例患者达2级以上改善外,其余患者均获得行走功能,Frankel分级达E级.③椎管狭窄面积术前平均为68.9%,术后椎管无狭窄.④术前脊柱后凸成角15°～30°,术后为0°～6°,术后脊柱后凸角较术前明显改善.结论经前路减压直接彻底,为脊髓神经功能的恢复提供了良好环境.史塞克胸腰椎前路钢板内固定系统治疗胸腰椎爆裂型骨折并截瘫患者可以有效地恢复脊柱生理弯曲,且操作简单,固定牢固,具有内固定材料的生物学特征.     

Correlation of history and physical examination with imaging in traumatic near-shore aquatic head and spinal injury

ObjectiveIt remains unclear whether clinicians can rely on specific symptoms and signs to detect or exclude serious head and spinal injury sustained during near-shore aquatic activities. Our study investigated patients' history of present illness (HPI) and physical examination (PE) for their utility in detecting serious head and spinal injury.MethodsWe conducted a multicenter retrospective comparative analysis of adult patients who were transported from the beach in Ocean City, Maryland, to three nearby emergency departments for possible spinal injury from 2006 through 2017. Patients suspected to have any spinal injury from beach activities were eligible. We excluded patients who could not verbalize their symptoms or with insufficient emergency department records. We compared components of each patient's HPI and PE with radiologic evidence of spinal injury. We calculated sensitivity, specificity, and negative and positive likelihood ratios (LRs).ResultsWe analyzed 278 patients with suspected spinal injury. Midline spinal tenderness was associated with increased likelihood of thoracic (LR+ 2.6) and lumbar spinal fractures (LR+ 3.5). HPI complaints of paralysis (LR+ 13.9) and sensory loss (LR+ 5.8) had strong associations with spinal cord injuries. Weakness found through PE was also associated with spinal cord injury (LR+ 5.3).ConclusionsWe identified several components of the clinical evaluation that had clinically significant association with spinal injuries from beach-related trauma. While prospective studies are needed to confirm our observations, clinicians may consider these high-risk features in patients with beach-related trauma and adjust testing and level of care appropriately.     

后路治疗胸腰段脊柱骨折椎弓根螺钉位置的探讨

目的探讨后路治疗胸腰段脊柱骨折术中的椎弓根螺钉植入的位置。方法回顾性分析应用RF、AF内固定系统治疗胸腰段脊柱骨折38例。术前测量X线片上椎弓根与上一椎体同侧下关节突的位置关系，确定椎弓根钉入钉点，在C臂X线机透视下，应用后路切开复位后，RF、AF椎弓根系统内固定。结果术后行X线片检查，所有患者手术均获成功，术后无神经症状加重或出现新的神经症状者，无内固定失败及伤椎高度明显丢失者。结论术前测量胸腰段脊柱骨折X线片上椎弓根与同侧上一椎体下关节突相互位置，为选择椎弓根螺钉的入钉点提供了一种新方法。