脊柱爆裂骨折的X线与CT诊断及评价

目的 :分析脊柱爆裂骨折的X线、CT表现 ,并评价其诊断价值和限度以及对临床治疗中的指导作用。方法 :回顾性分析 98例脊柱爆裂骨折的影像表现和临床资料 ,其中颈椎 12例 ,胸椎 16例 ,胸腰椎交界 5 0例 ,腰椎 2 0例 ;男 65例 ,女 3 3例 ,平均年龄 3 5岁。外伤后全部摄取X线正侧位片 ;73例行CT平扫 ,其中 3 4例行CT多平面重建。结果 :X线、CT表现为椎体高度减低、终板骨折移位突入椎管内、椎板骨折、椎体侧突成角后移、椎管狭窄、小关节脱位 ,棘突间或椎弓根间距增大、脊髓受压改变、椎间盘突出及椎旁软组织变化。结论 :投照质量良好的平片对脊柱爆裂骨折的诊断有一定价值 ,但需与单纯性压缩骨折鉴别 ,明确诊断需CT证实。CT能较清楚显示脊柱的三柱结构 ,对脊柱爆裂性骨折能做出较全面准确的诊断 ,尤其是对骨折线显示、小关节脱位、椎管损伤及稳定性的判断CT有着明显的优越性。平片对脊柱爆裂骨折的指导治疗作用不大 ,CT对其有一定的价值。但由于对椎间盘损伤、脊髓受损及椎旁软组织显示的局限性 ,其对治疗指导有一定的限度。

X-ray and CT diagnosis and evaluation of the vertebral burst fractures

Objective:To analyze X-ary and CT findings and evaluate the clinical value and limitation of X-ray and CT in diagnosis and directing management of vertebral burst fractures (VBF).Methods: The imaging features and clinical data of 98 VBF were analyzed,including cervical vertebrae (n=12),thoracic vertebrae (n=16),thoracolumbar area (n=50) and lumbar vertebrae in 20 cases.There were 65 males and 33 females.The average age was 35 years.Anteroposterior and lateral radiographs were taken in all patients,while CT scan in 73 cases,in 34 of which multi-planar reconstruction was made.Results:X-ary and CT findings showed decrease of vertebral height,displacement of fractured end-plate with protruding into the spinal canal,laminar fracture,narrowed canal,spinal cord compression,dislocation of the zygapophyseal joints,increase of interspinous or interpediculate distance and disc herniations.Conclusions:Plain film has some values in diagnosis of VBF.Precise diagnosis can be made by CT. CT could display the three columns structure of spine.Compared with plain film,CT provides further information on fracture line,dislocation of zygapoghyseal joints,narrowed canal and the stability of the vertebrae.