脊柱爆裂性骨折的影像学评价

目的探讨脊柱爆裂性骨折的X线平片、CT与MR的诊断价值。方法51例脊柱爆裂性骨折患者,其中颈椎3例,胸椎18例,腰椎30例,所有病例均行X线平片、CT及MRI检查,对其影像学资料进行分析比较。结果X线平片表现为椎体前后部高度缩短,椎体前后径、横径增宽和(或)椎弓根间距增宽,棘突间距增宽,骨折片突入椎管等爆裂性骨折表现28例(54.90%);与单纯压缩性骨折表现相似20例(39.21%);漏诊骨折3例(5.88%)。CT主要表现为椎体纵、横形多处或单处骨折49例(96.07%);骨折片向后突入椎管,椎管狭窄35例(68.62%);脊柱附件骨折22例(43.14%)。MRI同时还显示脊髓损伤35例(68.62%),椎间盘损伤29例(56.86%),硬膜外血肿12例(23.52%),后纵韧带断裂6例(11.76%)。结论X线平片是常规检查,但诊断爆裂性骨折有明显局限性,对单纯压缩性骨折或未见骨折而有神经症状者均须行CT或MRI检查;CT对显示骨折及骨折片移位优于MRI;而MRI显示椎管内神经损伤优于CT;CT与MRI两者结合对脊柱爆裂性骨折临床治疗具有重要的指导意义。

Imaging assessment of vertebral burst fracture

Objective To investigate the diagnostic value of radiography, CT and MRI in diagnosis of vertebral burst fracture.Methods 51 patients with vertebral burst fracture were evaluated with X- ray, CT and MRI, including 3 cases in cervical vertebra, 18 cases in thoracic vertebra, and 30 cases in lumbar vertebra. The imaging features were comparatively studied. Results Radiography showed decreased height of the vertebral body, increased antero- posterior diameter and the transverse diameter, and/or the widened inter- pedicle distance, the inter- spinous distance, as well as the bony fragment inserted into the vertebral canal in 28 cases(54.90% ). X- ray findings similar to the compression fracture were revealed in 20 cases(39.21% ).And missed diagnosis was made in 3 cases (5.88% ). CT clearly demonstrated the vertebral body vertically or transversely burst crack in 49 cases (96.07% ); bony fragment inserted into the vertebral canal and narrowed vertebral canal in 35 cases(68.62% );fracture of spinal appendix in 22 cases(43.14% ).Meanwhile MRI showed abnormal signals within the spinal cord in 35 cases (68.62% ), injured intervertebral disk in 29 cases(56.86% ), extradural hematoma in 12 cases(23.52% ) and torn posterior longitudinal ligament in 6 cases(11.76% ).Conclusions Radiography is the routine examination, while with limited diagnostic value in vertebral burst fracture. These patients who have nervous symptoms with simple compression fracture or unremarkable on X- ray should receive the CT or MRI examination. CT is better than MRI in demonstrating the fracture and the displaced bony fragment, while MRI is superior to CT in showing nervous injuries. CT and MRI will provide comprehensive information guiding clinical treatment of vertebral burst fracture.